Individual
MR. EBENEZER OGUNTUASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
611 E LANDIS AVE, VINELAND, NJ 08360-8004
(856) 794-2100
(856) 794-2120
Mailing address
611 E LANDIS AVE, VINELAND, NJ 08360-8004
(856) 794-2100
(856) 794-2120
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA00598500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000146
US HEALTHCARE
NJ
01
—
2115735000
AMERIHEALTH
NJ
01
—
5294643
AETNA US HEALTHCARE
NJ
01
—
532743
BLUE SHIELD OF PA
PA
01
—
P00040938
RAILROAD MEDICARE
NJ
Enumeration date
02/22/2006
Last updated
05/11/2011
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