Provider Demographics
NPI:1952880353
Name:OZIMS, IKENNA MADUFOR (DNP)
Entity Type:Individual
Prefix:DR
First Name:IKENNA
Middle Name:MADUFOR
Last Name:OZIMS
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-2554
Mailing Address - Country:US
Mailing Address - Phone:201-878-6442
Mailing Address - Fax:
Practice Address - Street 1:625 UNION ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-2554
Practice Address - Country:US
Practice Address - Phone:201-878-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2233767363LP2300X
NJ26NJ00847000363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care