Provider Demographics
NPI:1003979048
Name:UFONDU, EBELE EDITH (MD)
Entity Type:Individual
Prefix:MRS
First Name:EBELE
Middle Name:EDITH
Last Name:UFONDU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 WHITEHORSE AVENUE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610
Mailing Address - Country:US
Mailing Address - Phone:609-581-4800
Mailing Address - Fax:609-581-9980
Practice Address - Street 1:941 WHITEHORSE AVENUE
Practice Address - Street 2:SUITE 14
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610
Practice Address - Country:US
Practice Address - Phone:609-581-4800
Practice Address - Fax:609-581-9980
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60762207R00000X
PAMD052318L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6316102Medicaid
223738861OtherBLUE CROSS BLUE SHIELD
2465330OtherAETNA HMO
2465330OtherAETNA HMO
F88622Medicare UPIN