Provider Demographics
NPI:1548004849
Name:ODEK MEDICAL CARE & CONSULTING SERVICES
Entity type:Organization
Organization Name:ODEK MEDICAL CARE & CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ODEKUNLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-357-5986
Mailing Address - Street 1:181 FRANKLIN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2900
Mailing Address - Country:US
Mailing Address - Phone:973-320-2625
Mailing Address - Fax:973-320-2626
Practice Address - Street 1:181 FRANKLIN AVE STE 301
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2900
Practice Address - Country:US
Practice Address - Phone:973-320-2625
Practice Address - Fax:973-320-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty