Provider Demographics
NPI:1457038770
Name:EZEADI, KELECHI OGBONNAYA
Entity Type:Individual
Prefix:
First Name:KELECHI
Middle Name:OGBONNAYA
Last Name:EZEADI
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 1:6 CORNWALL CT STE B
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3347
Mailing Address - Country:US
Mailing Address - Phone:732-250-3273
Mailing Address - Fax:
Practice Address - Street 1:195 MAIN ST APT 7B
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1153
Practice Address - Country:US
Practice Address - Phone:862-246-0984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06443700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker