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General NPI Number Information
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NPI Number | 1124588033
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Entity Type | Individual
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Provider Name | OMOROVBIYE EWEKA
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Gender | Female
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 1980 SPRINGFIELD AVE STE 9D
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-3438
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Country | US
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Telephone | 973-762-1800
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Fax | 973-762-1808
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Provider Business Mailing Address
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Address Line | 570 S 10TH ST # 3
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City | NEWARK
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State | NJ
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Zip | 07103-1827
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Country | US
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Telephone | 908-422-3146
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Fax | 973-762-1808
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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