Provider Demographics
NPI:1730277476
Name:OLOKOSE, TEMITAYO (CRNA)
Entity type:Individual
Prefix:MISS
First Name:TEMITAYO
Middle Name:
Last Name:OLOKOSE
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LUCILLE CT
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-2867
Mailing Address - Country:US
Mailing Address - Phone:917-359-4582
Mailing Address - Fax:732-926-8663
Practice Address - Street 1:591 STUYVESANT AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-2404
Practice Address - Country:US
Practice Address - Phone:973-375-9743
Practice Address - Fax:973-373-0895
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00290500207LP2900X, 367500000X
NY494266367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ60075Medicare UPIN
NYR5C351Medicare ID - Type Unspecified