Provider Demographics
NPI:1902508385
Name:ABLE HEALTHCARE NURSE PRACTITIONER IN PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:ABLE HEALTHCARE NURSE PRACTITIONER IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FAUSAT
Authorized Official - Middle Name:F
Authorized Official - Last Name:ODUBIYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-471-3560
Mailing Address - Street 1:1143 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5532
Mailing Address - Country:US
Mailing Address - Phone:718-693-4121
Mailing Address - Fax:
Practice Address - Street 1:215 MAIN STREET
Practice Address - Street 2:
Practice Address - City:RANCOCAS,WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08073
Practice Address - Country:US
Practice Address - Phone:609-471-3560
Practice Address - Fax:833-520-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty