Provider Demographics
NPI:1336415553
Name:CHIJIOKE, GEORGIA EZINNE (APN)
Entity type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:EZINNE
Last Name:CHIJIOKE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:GEORGIA
Other - Middle Name:EZINNE
Other - Last Name:CHIORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:39 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:940 CEDAR BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4170
Practice Address - Country:US
Practice Address - Phone:732-475-6152
Practice Address - Fax:732-475-6172
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00828800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health