1215621966 NPI number — OLUWAPELUMI OLUWOLE M.D

Table of content: OLUWAPELUMI OLUWOLE M.D (NPI 1215621966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215621966 NPI number — OLUWAPELUMI OLUWOLE M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLUWOLE
Provider First Name:
OLUWAPELUMI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215621966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/08/2024
NPI Reactivation Date:
10/16/2025

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
128 WILLIAM STREET ENGLEWOOD, NEW JERSEY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
862-622-1938
Provider Business Mailing Address Fax Number:
201-894-0839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 ENGLE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
234-706-9697
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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