Provider Demographics
NPI:1972858736
Name:BILEWU, EBENEZER O-A (DC)
Entity Type:Individual
Prefix:DR
First Name:EBENEZER
Middle Name:O-A
Last Name:BILEWU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 W JIMMIE LEEDS RD STE 301
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9418
Mailing Address - Country:US
Mailing Address - Phone:609-573-5310
Mailing Address - Fax:609-241-1922
Practice Address - Street 1:76 W JIMMIE LEEDS RD STE 301
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9418
Practice Address - Country:US
Practice Address - Phone:609-573-5310
Practice Address - Fax:606-573-5310
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00702600111NR0400X, 111NS0005X, 111NX0100X, 111N00000X, 111NR0200X, 111NN0400X, 111NN1001X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60114338OtherHORIZON NJ HEALTH
NJ3893360000OtherAMERIHEALTH NEW JERSEY
NJ3893359000OtherAMERIHEALTH NEW JERSEY
NJ3893360000OtherAMERIHEALTH NEW JERSEY