Provider Demographics
NPI:1053172965
Name:EMELE, CHIDINMA LAURETTA
Entity type:Individual
Prefix:
First Name:CHIDINMA
Middle Name:LAURETTA
Last Name:EMELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RIDGEDALE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1106
Mailing Address - Country:US
Mailing Address - Phone:201-688-6498
Mailing Address - Fax:
Practice Address - Street 1:14 RIDGEDALE AVE STE 103
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1106
Practice Address - Country:US
Practice Address - Phone:201-688-6498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14992900163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent