Provider Demographics
NPI:1255568200
Name:EMEJURU, IJEAMAKA
Entity type:Individual
Prefix:
First Name:IJEAMAKA
Middle Name:
Last Name:EMEJURU
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 1:46 LAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5171
Mailing Address - Country:US
Mailing Address - Phone:717-710-7107
Mailing Address - Fax:
Practice Address - Street 1:220 DAVIDSON AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4149
Practice Address - Country:US
Practice Address - Phone:732-907-0709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14985300363LP0808X, 363LP0808X
NJ26NR20759500163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical