MEDICARE: BLESSED HEALTHCARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1841149853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLESSED HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	615 S 19TH ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-1116
Country	:	US
Telephone Number	:	973-964-4720
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 S 19TH ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-1116
Country	:	US
Telephone Number	:	973-964-4720
Fax Number	:

Authorized Official
Title or Position	:	PPMHNP-BC
Name	:	MATHIAS OMON OLOGBOSELE
Credential	:
Telephone Number	:	973-964-4720

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	01/23/2026

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