# ICONICHEALTH LLC

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

## Provider details

- **NPI number:** 1972106292
- **Authorized official:** MR. OLASUMBO JOSEPH OLADERU NURSE PRACTITIONER (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (609) 321-0233

## Contact information

- **Practice address:** 1901 N OLDEN AVENUE EXT STE 11A, EWING, NJ 08618-2100
- **Practice address phone:** (609) 583-4970
- **Practice address fax:** (609) 323-7385
- **Mailing address:** 1901 N OLDEN AVENUE EXT STE 11A, EWING, NJ 08618-2100
- **Mailing address phone:** (609) 583-4970
- **Mailing address fax:** (609) 323-7385

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/19/2020
- **Last updated:** 01/28/2026