Organization
EXCELSIOR GRACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLUWABUNMI OMOTAYO APN (OWNER)
(347) 302-1212
Entity
Organization
Contact information
Practice address
959 W 4TH ST, PLAINFIELD, NJ 07063-1372
(347) 302-1212
Mailing address
959 W 4TH ST, PLAINFIELD, NJ 07063-1372
(347) 302-1212
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/01/2025
Last updated
11/04/2025
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