Provider Demographics
NPI:1669404687
Name:OZONUWE, GABRIEL OBI (PA, DC, MSACN)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:OBI
Last Name:OZONUWE
Suffix:
Gender:M
Credentials:PA, DC, MSACN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SANDCASTLE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-5341
Mailing Address - Country:US
Mailing Address - Phone:732-986-3893
Mailing Address - Fax:732-961-6854
Practice Address - Street 1:1254 S BROAD ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-6256
Practice Address - Country:US
Practice Address - Phone:609-212-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00019100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5723L34971OtherNPI 1669404687
NJ095670Medicare PIN
NJ5723L34971OtherNPI 1669404687
NJS47691Medicare UPIN
S47691Medicare UPIN
NJ095670WJ8Medicare PIN