Provider Demographics
NPI:1265680912
Name:HAMILTON TRENTON URGENT CARE CENTER, LLC
Entity Type:Organization
Organization Name:HAMILTON TRENTON URGENT CARE CENTER, LLC
Other - Org Name:OZEDI HEALTH CENTER FOR INTEGRATIVE & FUNCTIONAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN. DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:OZONUWE
Authorized Official - Suffix:
Authorized Official - Credentials:DR OF MED/ DC/PAC/
Authorized Official - Phone:609-212-4404
Mailing Address - Street 1:1254 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-6256
Mailing Address - Country:US
Mailing Address - Phone:609-212-4404
Mailing Address - Fax:609-341-9086
Practice Address - Street 1:1254 S BROAD ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-6256
Practice Address - Country:US
Practice Address - Phone:609-218-5637
Practice Address - Fax:609-218-5639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-07
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X, 261QU0200X
NJ25MP00019100261QU0200X
NJ25MA05212700261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8793506Medicaid