Provider Demographics
NPI:1326532359
Name:ILOZUE, CHIJIOKE VICTOR
Entity Type:Individual
Prefix:MR
First Name:CHIJIOKE
Middle Name:VICTOR
Last Name:ILOZUE
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 1:3610 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3123
Mailing Address - Country:US
Mailing Address - Phone:732-824-2055
Mailing Address - Fax:
Practice Address - Street 1:3610 MAIN ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-3123
Practice Address - Country:US
Practice Address - Phone:732-824-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY999999999174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator