Provider Demographics
NPI:1649825944
Name:GREEN OAK PROFESSIONAL HEALTH SERVICES
Entity type:Organization
Organization Name:GREEN OAK PROFESSIONAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAZEEM
Authorized Official - Middle Name:ALAO
Authorized Official - Last Name:OLAJIDE
Authorized Official - Suffix:
Authorized Official - Credentials:APN-C
Authorized Official - Phone:973-392-0217
Mailing Address - Street 1:735 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-1740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 MILLBURN AVE STE 201
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1935
Practice Address - Country:US
Practice Address - Phone:973-392-0217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health