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General NPI Number Information
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NPI Number | 1790935377
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Entity Type | Individual
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Provider Name | MR. EFOSA CHARLES EHIGIE
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Gender | Male
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Dates
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Enumeration Date | 09/19/2008
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Last Update Date | 01/04/2025
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Provider Practice Location Address
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Address Line | 1001 UNIVERSITY AVE APT 3J
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City | BRONX
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State | NY
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Zip | 10452-4260
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Country | US
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Telephone | 917-345-0521
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Fax |
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Provider Business Mailing Address
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Address Line | 1084 LIBERTY AVE
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City | UNION
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State | NJ
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Zip | 07083-4836
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Country | US
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Telephone | 917-345-0521
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ15206000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 589213-1
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License Number State | NY
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