Provider Demographics
NPI:1780119156
Name:EWEKA, OSAGIE
Entity type:Individual
Prefix:
First Name:OSAGIE
Middle Name:
Last Name:EWEKA
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 1:33 BOSSI AVE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2001
Mailing Address - Country:US
Mailing Address - Phone:508-801-3024
Mailing Address - Fax:
Practice Address - Street 1:33 BOSSI AVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2001
Practice Address - Country:US
Practice Address - Phone:508-801-3024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health