Healthcare Provider Details

I. General information

NPI: 1306538707
Provider Name (Legal Business Name): MR. PIUS CHUKWUDI EFOBI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 WESTBOURNE AVE
LONG BRANCH NJ
07740-5527
US

IV. Provider business mailing address

474 WESTBOURNE AVE
LONG BRANCH NJ
07740-5527
US

V. Phone/Fax

Practice location:
  • Phone: 732-841-5530
  • Fax:
Mailing address:
  • Phone: 732-841-5530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01465600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: