Provider Demographics
NPI:1679271506
Name:KOLAWOLE, ADEDOYIN T (APN)
Entity type:Individual
Prefix:
First Name:ADEDOYIN
Middle Name:T
Last Name:KOLAWOLE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 ROUTE 1 # 1029
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2609
Mailing Address - Country:US
Mailing Address - Phone:732-447-9470
Mailing Address - Fax:732-790-8133
Practice Address - Street 1:485C US HIGHWAY 1 S STE 100-101
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-3037
Practice Address - Country:US
Practice Address - Phone:732-447-9470
Practice Address - Fax:732-790-8133
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NR18320000163W00000X
NJ26NJ01473800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse