Basic Information
| Provider Information | |||||||||
| NPI: | 1003818881 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EZEMA | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27 NASHAWAY DR | ||||||||
| Address2: | |||||||||
| City: | RINGOES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085512056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9083384626 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | EAST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070182819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732668400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 05/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 25MA06308200 | NJ | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 25MA06308200 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6862004 | 05 | NJ | MEDICAID |