Provider Demographics
NPI:1790935377
Name:EHIGIE, EFOSA CHARLES
Entity type:Individual
Prefix:MR
First Name:EFOSA
Middle Name:CHARLES
Last Name:EHIGIE
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 1:1084 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4836
Mailing Address - Country:US
Mailing Address - Phone:917-345-0521
Mailing Address - Fax:
Practice Address - Street 1:1001 UNIVERSITY AVE
Practice Address - Street 2:APT 3J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-4260
Practice Address - Country:US
Practice Address - Phone:917-345-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY589213-1163W00000X
NJ26NJ15206000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse