Provider Demographics
NPI:1902642333
Name:FREEMAN, EZEKIEL BLOWINEE
Entity type:Individual
Prefix:
First Name:EZEKIEL
Middle Name:BLOWINEE
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 MILLENNIUM DR
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1051
Mailing Address - Country:US
Mailing Address - Phone:201-920-5669
Mailing Address - Fax:
Practice Address - Street 1:25 TIMBER LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-3825
Practice Address - Country:US
Practice Address - Phone:201-920-7696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171R00000XOther Service ProvidersInterpreter
No171W00000XOther Service ProvidersContractor
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker