Provider Demographics
NPI:1033226931
Name:AMEGADZIE, RICHARD KOKU (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KOKU
Last Name:AMEGADZIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 BROWER CT
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-8349
Mailing Address - Country:US
Mailing Address - Phone:201-866-1646
Mailing Address - Fax:201-866-1646
Practice Address - Street 1:1044 E HAZELWOOD AVE
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-5818
Practice Address - Country:US
Practice Address - Phone:732-381-3636
Practice Address - Fax:732-381-5977
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 72097207R00000X
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H17582Medicare UPIN
178794Medicare ID - Type Unspecified