Provider Demographics
NPI:1942559315
Name:AZOH, FONJECK ERIC
Entity Type:Individual
Prefix:
First Name:FONJECK
Middle Name:ERIC
Last Name:AZOH
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 1:2504 QUEENS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3646
Mailing Address - Country:US
Mailing Address - Phone:202-413-0860
Mailing Address - Fax:
Practice Address - Street 1:2504 QUEENS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3646
Practice Address - Country:US
Practice Address - Phone:202-413-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide