Organization
OMADESALA PSYCHIATRIC SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN D VO (OWNER)
(212) 365-0448
Entity
Organization
Contact information
Practice address
285 DURHAM AVE STE 2A, BUILDING 6, SOUTH PLAINFIELD, NJ 07080-2546
(908) 548-8533
(908) 548-8532
Mailing address
PO BOX 9, ROOSEVELT, NJ 08555-0009
(609) 301-5089
(831) 303-5089
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9760812
AETNA
NJ
Enumeration date
01/23/2012
Last updated
01/23/2012
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