Healthcare Provider Details

I. General information

NPI: 1487043089
Provider Name (Legal Business Name): ANTHONY OGBONNAYA NJOKU M.ED, M. SC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LAMP POST LN
CHERRY HILL NJ
08003-1208
US

IV. Provider business mailing address

19 LAMP POST LN
CHERRY HILL NJ
08003-1208
US

V. Phone/Fax

Practice location:
  • Phone: 215-219-5172
  • Fax:
Mailing address:
  • Phone: 215-219-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBH001303
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: