Healthcare Provider Details

I. General information

NPI: 1003065780
Provider Name (Legal Business Name): NGOZI ERONDU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 BAIRD RD
MILLSTONE TOWNSHIP NJ
08535-8180
US

IV. Provider business mailing address

63 BAIRD RD
MILLSTONE TOWNSHIP NJ
08535-8180
US

V. Phone/Fax

Practice location:
  • Phone: 908-816-1233
  • Fax:
Mailing address:
  • Phone: 908-816-1233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMA072304
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: