Individual
CAROLINE C EJIOGU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
23214 MERRICK BLVD, LAURELTON, NY 11413-2115
(718) 528-3432
Mailing address
10811 171ST PL, JAMAICA, NY 11433-3027
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
314036
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NX11550B
—
NY
Enumeration date
10/16/2017
Last updated
10/16/2017
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