Provider Demographics
NPI:1558108159
Name:EZIRIKE, RAYMOND IKECHUKWU III (ACSM-EP)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:IKECHUKWU
Last Name:EZIRIKE
Suffix:III
Gender:M
Credentials:ACSM-EP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:91 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1467
Mailing Address - Country:US
Mailing Address - Phone:860-803-2319
Mailing Address - Fax:
Practice Address - Street 1:118 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4593
Practice Address - Country:US
Practice Address - Phone:860-803-2319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT1070016224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist