# GRACE MEDICAL CONSULT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104370915
- **Authorized official:** MR. ADEWALE ADEFOWOJU MSN, APN, PMHNP-BC (MEDICAL DIRECTOR)
- **Authorized official phone:** (908) 693-5036

## Contact information

- **Practice address:** 40 UNION AVE, 3RD FL. STE 301, IRVINGTON, NJ 07111-3277
- **Practice address phone:** (973) 996-2170
- **Mailing address:** 40 UNION AVE, 3RD FL. STE 301, IRVINGTON, NJ 07111-3277
- **Mailing address phone:** (973) 996-2170

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 26NJ00196200 | NJ | Yes |

## Other

- **Enumeration date:** 08/09/2016
- **Last updated:** 08/09/2016