Healthcare Provider Details

I. General information

NPI: 1225342322
Provider Name (Legal Business Name): EFOSAHEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 LIBERTY AVE
UNION NJ
07083-4836
US

IV. Provider business mailing address

1084 LIBERTY AVE
UNION NJ
07083-4836
US

V. Phone/Fax

Practice location:
  • Phone: 917-345-0521
  • Fax:
Mailing address:
  • Phone: 917-345-0521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number589213
License Number StateNY

VIII. Authorized Official

Name: EFOSA EHIGIE
Title or Position: HEALTH CARE PROVIDER
Credential: RN
Phone: 917-345-0521