Provider Demographics
NPI:1184101024
Name:FALAE, TEJUMADE VERONICA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:TEJUMADE
Middle Name:VERONICA
Last Name:FALAE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6O EVERGREEN PLACE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018
Mailing Address - Country:US
Mailing Address - Phone:973-280-2005
Mailing Address - Fax:862-520-8852
Practice Address - Street 1:6O EVERGREEN PLACE
Practice Address - Street 2:SUITE 307
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018
Practice Address - Country:US
Practice Address - Phone:973-280-2005
Practice Address - Fax:862-520-8852
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR07196800163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ82-2679724Medicaid