Individual provider · NPI-1

Omotara Joan Adewale, MSN, NP-C, FNP-BC

Nurse Practitioner, Family · Staten Island, NY

NPI number1366985251

StatusActive

Last updated in NPPESJun 25, 2026

Details

NPI: 1366985251
Entity type: Individual (NPI-1)
Name: Omotara Joan Adewale
Credential: MSN, NP-C, FNP-BC
Sex: Female
Sole proprietor: Yes
Enumeration date: Nov 23, 2016
Certification date: Jun 25, 2026
Last updated: Jun 25, 2026

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363LF0000X	Nurse Practitioner, Family	F341251-1	NY	Yes

Practice location

260 Christopher Ln Ste 201
Staten Island, NY 10314-1650

Phone 929-367-0510 · Fax 929-367-0511

Mailing address

1275 York Ave
New York, NY 10065-6007

Phone 212-639-2000

Other practice locations

1275 York Ave
New York, NY 10065-6007

Phone 646-465-4656

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