Healthcare Provider Details

I. General information

NPI: 1235856600
Provider Name (Legal Business Name): LEO ONYEKWERE ONUOHA MSN, RN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 MAYOR GIBSON BLVD STE 606
NEWARK NJ
07102-4537
US

IV. Provider business mailing address

300 BAYARD DR
WILLIAMSTOWN NJ
08094-8844
US

V. Phone/Fax

Practice location:
  • Phone: 201-822-1161
  • Fax:
Mailing address:
  • Phone: 856-629-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ14845100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number26NR16050500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NR16050500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: