Provider Demographics
NPI:1962609909
Name:OZURUMBA, DOROTHY (NP)
Entity type:Individual
Prefix:MISS
First Name:DOROTHY
Middle Name:
Last Name:OZURUMBA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 EASTON AVE STE 11-630
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1648
Mailing Address - Country:US
Mailing Address - Phone:848-237-9715
Mailing Address - Fax:
Practice Address - Street 1:1075 EASTON AVE STE 11-258
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1648
Practice Address - Country:US
Practice Address - Phone:848-237-9715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00024900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0250376Medicaid