Provider Demographics
NPI:1487302493
Name:ONYEAGORO, VIVIAN CHIDINMA
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:CHIDINMA
Last Name:ONYEAGORO
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:PO BOX 1432
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-5432
Mailing Address - Country:US
Mailing Address - Phone:862-888-6190
Mailing Address - Fax:
Practice Address - Street 1:15 38TH ST APT C9
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1284
Practice Address - Country:US
Practice Address - Phone:862-888-6190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator