Individual provider · NPI-1

Phillips Ajibade

Home Health Aide · Newark, NJ

NPI number1871322388
StatusActive
Last updated in NPPESAug 1, 2024

Details

NPI
1871322388
Entity type
Individual (NPI-1)
Name
Phillips Ajibade
Sex
Male
Sole proprietor
No
Enumeration date
Aug 1, 2024
Certification date
Jul 31, 2024
Last updated
Aug 1, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
374U00000X Home Health Aide––Yes
172V00000X Community Health Worker––

Practice location

35 Ross St
Newark, NJ 07114-1127

Phone 973-393-5153

Mailing address

35 Ross St
Newark, NJ 07114-1127

Phone 973-393-5153

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