Provider Demographics
NPI:1386087419
Name:OMERONYE, AMOGE EVA (MASTER'S DEGREE)
Entity type:Individual
Prefix:
First Name:AMOGE
Middle Name:EVA
Last Name:OMERONYE
Suffix:
Gender:F
Credentials:MASTER'S DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SALEM WAY
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3773
Mailing Address - Country:US
Mailing Address - Phone:856-988-0353
Mailing Address - Fax:
Practice Address - Street 1:31 SALEM WAY
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3773
Practice Address - Country:US
Practice Address - Phone:856-988-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker