Provider Demographics
NPI:1952688012
Name:EJIOGU, CHTISTIANA (SW)
Entity Type:Individual
Prefix:
First Name:CHTISTIANA
Middle Name:
Last Name:EJIOGU
Suffix:
Gender:F
Credentials:SW
Other - Prefix:MRS
Other - First Name:CHRISTIANA
Other - Middle Name:NNEKA
Other - Last Name:EJIOGU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SW
Mailing Address - Street 1:29 ANDROS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2003
Mailing Address - Country:US
Mailing Address - Phone:718-982-6982
Mailing Address - Fax:718-982-6916
Practice Address - Street 1:2795 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5866
Practice Address - Country:US
Practice Address - Phone:718-982-6982
Practice Address - Fax:718-982-6916
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXW073853503-07OtherAETNA