Healthcare Provider Details

I. General information

NPI: 1952880353
Provider Name (Legal Business Name): IKENNA MADUFOR OZIMS DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIVERFRONT PLZ STE 300
NEWARK NJ
07102-5412
US

IV. Provider business mailing address

625 UNION ST
LINDEN NJ
07036-2554
US

V. Phone/Fax

Practice location:
  • Phone: 201-273-7047
  • Fax: 855-998-4358
Mailing address:
  • Phone: 201-878-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ00847000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2233767
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: