Provider Demographics
NPI:1033185145
Name:OKEREKE, NDUBUEZE CLEMENT JOB (MD; MPH)
Entity Type:Individual
Prefix:DR
First Name:NDUBUEZE
Middle Name:CLEMENT JOB
Last Name:OKEREKE
Suffix:
Gender:M
Credentials:MD; MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8-61 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1509
Mailing Address - Country:US
Mailing Address - Phone:201-703-3713
Mailing Address - Fax:201-703-3713
Practice Address - Street 1:4422 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2545
Practice Address - Country:US
Practice Address - Phone:718-960-9415
Practice Address - Fax:718-960-9414
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222948207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY222948OtherLICENCE
NY02204300Medicaid
NY7936493OtherAETNA PROVIDER
NY572E51OtherEMPIRE BC/BS PROVIDER
NY9522538OtherCIGNA PROVIDER
NY292407AOtherMAGNACARE PROVIDER
NY48612POtherHIP PROVIDER
NY48612POtherHIP PROVIDER
NY9522538OtherCIGNA PROVIDER
NY572E51OtherEMPIRE BC/BS PROVIDER