Provider Demographics
NPI:1073182234
Name:OBENG, EMMANUEL (BSN RN)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:OBENG
Suffix:
Gender:M
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 IRVINE TURNER BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07108-3835
Mailing Address - Country:US
Mailing Address - Phone:862-279-8565
Mailing Address - Fax:
Practice Address - Street 1:307 IRVINE TURNER BLVD APT 1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-3835
Practice Address - Country:US
Practice Address - Phone:862-279-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17911400163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical