Provider Demographics
NPI:1831372309
Name:ANOSIKE, NGOZIKA ENZINMA (PA-C)
Entity type:Individual
Prefix:
First Name:NGOZIKA
Middle Name:ENZINMA
Last Name:ANOSIKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NGOZI
Other - Middle Name:VIDA
Other - Last Name:ANOSIKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:701 E MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4421
Mailing Address - Country:US
Mailing Address - Phone:215-901-5230
Mailing Address - Fax:
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-901-5230
Practice Address - Fax:215-399-5896
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051362363A00000X
DEC5-0001191363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA597586OtherMEDICARE GROUP
PACD4829OtherRR MEDICARE GROUP
PA122160Medicare PIN