Provider Demographics
NPI:1124305958
Name:IBEZIM, ADANNA
Entity type:Individual
Prefix:
First Name:ADANNA
Middle Name:
Last Name:IBEZIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 PASSAIC AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-1129
Mailing Address - Country:US
Mailing Address - Phone:201-719-9371
Mailing Address - Fax:
Practice Address - Street 1:276 PASSAIC AVE UNIT A
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-1129
Practice Address - Country:US
Practice Address - Phone:201-719-9371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01397800363LF0000X
NYF344186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty