Healthcare Provider Details

I. General information

NPI: 1003388703
Provider Name (Legal Business Name): CECILIA EZUDUEMOIH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WESCOTT DR
FLEMINGTON NJ
08822-4603
US

IV. Provider business mailing address

2100 WESCOTT DR
FLEMINGTON NJ
08822-4603
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-6100
  • Fax: 908-788-6184
Mailing address:
  • Phone: 908-788-6100
  • Fax: 908-788-6184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00888500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00888500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: