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General NPI Number Information
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NPI Number | 1285220764
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Entity Type | Individual
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Provider Name | KENECHUKWU EZEANYA PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 12/18/2020
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 1200 US HIGHWAY 22 STE 2000
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-2943
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Country | US
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Telephone | 732-558-9625
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Fax | 973-548-9450
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Provider Business Mailing Address
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Address Line | 1200 US HIGHWAY 22 STE 2000
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-2943
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Country | US
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Telephone | 737-325-5896
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Fax | 973-548-9450
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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 | 364SP0813X
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Taxonomy Name | Geropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 26NJ15281600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ15281600
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License Number State | NJ
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