Provider Demographics
NPI:1063120004
Name:IFEGWU, IROKA JI
Entity type:Individual
Prefix:
First Name:IROKA
Middle Name:JI
Last Name:IFEGWU
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JOY
Other - Middle Name:JI
Other - Last Name:ORJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:2660 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4928
Mailing Address - Country:US
Mailing Address - Phone:908-265-1691
Mailing Address - Fax:908-687-9733
Practice Address - Street 1:2660 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4928
Practice Address - Country:US
Practice Address - Phone:908-265-1691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2022026983363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner