Provider Demographics
NPI:1578075339
Name:EJIKE, CHINEDU
Entity Type:Individual
Prefix:
First Name:CHINEDU
Middle Name:
Last Name:EJIKE
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 1:951 E 228TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4611
Mailing Address - Country:US
Mailing Address - Phone:567-230-0014
Mailing Address - Fax:
Practice Address - Street 1:951 E 228TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4611
Practice Address - Country:US
Practice Address - Phone:567-230-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY740541163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse