Provider Demographics
NPI:1093322935
Name:MOLOKWU, OMEZIE A
Entity Type:Individual
Prefix:
First Name:OMEZIE
Middle Name:A
Last Name:MOLOKWU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 PINEHURST EST
Mailing Address - Street 2:
Mailing Address - City:LAKEHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:08733-2414
Mailing Address - Country:US
Mailing Address - Phone:848-459-0525
Mailing Address - Fax:
Practice Address - Street 1:1602 PINEHURST EST
Practice Address - Street 2:
Practice Address - City:LAKEHURST
Practice Address - State:NJ
Practice Address - Zip Code:08733-2414
Practice Address - Country:US
Practice Address - Phone:848-459-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01058700363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health