Provider Demographics
NPI:1295096584
Name:EJIOFOR, UDOKA JEREMIAH (PHD, MSN, PMHNP)
Entity type:Individual
Prefix:DR
First Name:UDOKA
Middle Name:JEREMIAH
Last Name:EJIOFOR
Suffix:
Gender:M
Credentials:PHD, MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 EVERGREEN PL
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2011
Mailing Address - Country:US
Mailing Address - Phone:862-233-2133
Mailing Address - Fax:
Practice Address - Street 1:134 EVERGREEN PL
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2011
Practice Address - Country:US
Practice Address - Phone:862-233-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-03
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401462-1363LP0808X
NJ26NJ00374300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health