Healthcare Provider Details

I. General information

NPI: 1215158936
Provider Name (Legal Business Name): APPOLONIA NGOZIKA ANIKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BERGEN ST
NEWARK NJ
07103-2496
US

IV. Provider business mailing address

921 TIMBERLINE DR
LAKE HOPATCONG NJ
07849-2458
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-6000
  • Fax:
Mailing address:
  • Phone: 862-259-1571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NO10930000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00549100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ00549100
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ00549100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: