Provider Demographics
NPI:1285480475
Name:EHIZE, EKA
Entity type:Individual
Prefix:
First Name:EKA
Middle Name:
Last Name:EHIZE
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 1:1435 MORRIS AVE STE 2H
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3316
Mailing Address - Country:US
Mailing Address - Phone:908-623-1234
Mailing Address - Fax:
Practice Address - Street 1:1435 MORRIS AVE STE 2H
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3316
Practice Address - Country:US
Practice Address - Phone:201-349-2644
Practice Address - Fax:973-732-9314
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18877400390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program