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NPI Code Detail

MEDICARE: P&P PSYCHIATRIC AND RECOVERY CENTER LLC.

MEDICARE: P&P PSYCHIATRIC AND RECOVERY CENTER LLC.
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner26NJ00654800NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
126NJ00654800OTHERNJLICENSE

General Provider Information

NPI Number : 1851887921
Entity Type Code : Organization
Provider Name (Legal Business Name) : P&P PSYCHIATRIC AND RECOVERY CENTER LLC.
Provider Business Mailing Address
First Line : 315 NOTTINGHAM WAY STE D5
Second Line :
City : UNION
State : NJ
Zip : 07083-7932
Country : US
Telephone Number : 190-849-9537
Fax Number :
Provider Business Practice Location Address
First Line : 11 DUNDAR RD STE 105
Second Line :
City : SPRINGFIELD
State : NJ
Zip : 07081-3513
Country : US
Telephone Number : 908-499-5375
Fax Number :
Authorized Official
Title or Position : NURSE PRACTITIONER
Name : OLUBUNMI ADETULE
Credential : PMHNP-BC, APN
Telephone Number : 862-297-3732
Provider Enumeration Date : 07/02/2018
Last Update Date : 11/21/2023

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Directions to “P&P PSYCHIATRIC AND RECOVERY CENTER LLC. ” Practice Location

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