Provider Demographics
NPI:1457662603
Name:NWOTITE, EZINNE UGOCHI (MD)
Entity Type:Individual
Prefix:DR
First Name:EZINNE
Middle Name:UGOCHI
Last Name:NWOTITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EZINNE
Other - Middle Name:UGOCHI
Other - Last Name:NWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1925 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-6713
Mailing Address - Country:US
Mailing Address - Phone:609-441-8146
Mailing Address - Fax:609-441-8002
Practice Address - Street 1:1925 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6713
Practice Address - Country:US
Practice Address - Phone:609-441-8146
Practice Address - Fax:609-441-8002
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08775000207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA08775000OtherPHYSICIAN LICENSE
NJ0240923Medicaid
NJ186323ZEMEMedicare PIN