Provider Demographics
NPI:1386301489
Name:EKEWEME, ANGELA EMOMOTIMI (PMHNP)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:EMOMOTIMI
Last Name:EKEWEME
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 HALSTEAD ST # 3
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-1102
Mailing Address - Country:US
Mailing Address - Phone:857-928-1854
Mailing Address - Fax:
Practice Address - Street 1:2500 PLAZA 5
Practice Address - Street 2:25TH FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07311
Practice Address - Country:US
Practice Address - Phone:201-308-8252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01227400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health