Provider Demographics
NPI:1285220764
Name:EZEANYA, KENECHUKWU (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KENECHUKWU
Middle Name:
Last Name:EZEANYA
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 ROUTE 22 W STE 30
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6516
Mailing Address - Country:US
Mailing Address - Phone:908-300-3396
Mailing Address - Fax:
Practice Address - Street 1:445 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2695
Practice Address - Country:US
Practice Address - Phone:609-582-0899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15281600364SP0813X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, GeropsychiatricGroup - Single Specialty