Ebenezer O-a Bilewu, DC
Individual provider Active NPI Chiropractor · Galloway, NJ
NPI 1972858736 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1972858736
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 38MC00702600 (NJ)
- Practice address
- 76 W Jimmie Leeds Rd Ste 301
Galloway, NJ 08205-9418 - Phone
- (609) 573-5310
- Fax
- (606) 573-5310
- NPI assigned
- Jul 18, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121130000372 | NJ | Practitioner - Chiropractic | 4880846617 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38MC00702600 | NJ | MD | Radiology Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Chiropractor | 111NR0400X | 38MC00702600 | NJ | |
| Sports Physician Chiropractor | 111NS0005X | 38MC00702600 | NJ | |
| Occupational Health Chiropractor | 111NX0100X | 38MC00702600 | NJ | |
| Chiropractor | 111N00000X | 38MC00702600 | NJ | Yes |
| Radiology Chiropractor | 111NR0200X | 38MC00702600 | NJ | |
| Neurology Chiropractor | 111NN0400X | 38MC00702600 | NJ | |
| Nutrition Chiropractor | 111NN1001X | 38MC00702600 | NJ | |
| Pediatric Chiropractor | 111NP0017X | 38MC00702600 | NJ |
Addresses
Primary practice location
76 W Jimmie Leeds Rd Ste 301
Galloway, NJ 08205-9418
Mailing address
76 W Jimmie Leeds Rd Ste 301
Galloway, NJ 08205-9418
Phone (609) 573-5310
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60114338 | Other | NJ | HORIZON NJ HEALTH |
| 3893360000 | Other | NJ | AMERIHEALTH NEW JERSEY |
| 3893359000 | Other | NJ | AMERIHEALTH NEW JERSEY |
Other providers in Galloway, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.