Healthcare Provider Details

I. General information

NPI: 1235539420
Provider Name (Legal Business Name): UGOCHI CHIAZOM EKEMEZIE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 US HIGHWAY 1
LAWRENCEVILLE NJ
08609-1821
US

IV. Provider business mailing address

113 S JOHNSTON AVE
HAMILTON NJ
08609-1821
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-8877
  • Fax:
Mailing address:
  • Phone: 609-510-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00477900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: