Healthcare Provider Details

I. General information

NPI: 1013637404
Provider Name (Legal Business Name): OPHELIA OSINACHI MATTHEWS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OPHELIA OSINACHI OKEBAGTA

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 PATTON DR
EWING NJ
08618-2533
US

IV. Provider business mailing address

252 CO RD 601 BELLE MEAD
BELLE MEAD NJ
08502
US

V. Phone/Fax

Practice location:
  • Phone: 267-608-3044
  • Fax:
Mailing address:
  • Phone: 908-281-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01347600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: