Provider Demographics
NPI:1720894306
Name:EGEONU, EMMANUELLA UJU
Entity type:Individual
Prefix:MRS
First Name:EMMANUELLA
Middle Name:UJU
Last Name:EGEONU
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 1:322 EASTERN PKWY APT 10
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-6714
Mailing Address - Country:US
Mailing Address - Phone:862-888-5533
Mailing Address - Fax:
Practice Address - Street 1:322 EASTERN PKWY APT 10
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-6714
Practice Address - Country:US
Practice Address - Phone:862-888-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities