Provider Demographics
NPI:1538610977
Name:OJONG, VALENTINE EKULE
Entity type:Individual
Prefix:
First Name:VALENTINE
Middle Name:EKULE
Last Name:OJONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4173 WOOD HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-3473
Mailing Address - Country:US
Mailing Address - Phone:513-307-3010
Mailing Address - Fax:
Practice Address - Street 1:4173 WOOD HILLS DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510
Practice Address - Country:US
Practice Address - Phone:513-307-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA81-4038745302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization