Provider Demographics
NPI:1053142687
Name:OMOLOYIN LLC
Entity type:Organization
Organization Name:OMOLOYIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ APN
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:OLANIRAN
Authorized Official - Last Name:OMOLOYIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-978-0650
Mailing Address - Street 1:48 PRESTS MILL RD
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2740
Mailing Address - Country:US
Mailing Address - Phone:973-978-0650
Mailing Address - Fax:973-642-4530
Practice Address - Street 1:114 CANTERBURY LN
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-5200
Practice Address - Country:US
Practice Address - Phone:973-978-0650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty