Healthcare Provider Details

I. General information

NPI: 1023267465
Provider Name (Legal Business Name): CHIOMA A EZEADICHIE D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 8TH ST
HAMMONTON NJ
08037-3347
US

IV. Provider business mailing address

PO BOX 7776
LANCASTER PA
17604-7776
US

V. Phone/Fax

Practice location:
  • Phone: 888-985-2727
  • Fax:
Mailing address:
  • Phone: 888-985-2727
  • Fax: 856-779-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MB08977000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: