Healthcare Provider Details

I. General information

NPI: 1932511367
Provider Name (Legal Business Name): CORDELIA HAPPY ENYAOSA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 TREMONT AVE ATTENTION PATIENT SERVICE
EAST ORANGE NJ
07018-1023
US

IV. Provider business mailing address

385 TREMONT AVE
EAST ORANGE NJ
07018-1023
US

V. Phone/Fax

Practice location:
  • Phone: 973-676-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00497000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: