Healthcare Provider Details

I. General information

NPI: 1427934033
Provider Name (Legal Business Name): ADAOBI EGBUCHUNAM
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1478 LESLIE ST
HILLSIDE NJ
07205-1212
US

IV. Provider business mailing address

1478 LESLIE ST
HILLSIDE NJ
07205-1212
US

V. Phone/Fax

Practice location:
  • Phone: 973-687-5015
  • Fax:
Mailing address:
  • Phone: 973-687-5015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15359600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: