Provider Demographics
NPI:1023599578
Name:ANIEGBUNA, EBERE
Entity type:Individual
Prefix:DR
First Name:EBERE
Middle Name:
Last Name:ANIEGBUNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2079 WOODBRIDGE AVE STE 1388
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4451
Mailing Address - Country:US
Mailing Address - Phone:908-531-5389
Mailing Address - Fax:
Practice Address - Street 1:2079 WOODBRIDGE AVE STE 1388
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4451
Practice Address - Country:US
Practice Address - Phone:908-531-5389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00849500363LP0808X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health