Provider Demographics
NPI:1093009649
Name:CHUKWUNEKE, PETER IKEM (PT)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:IKEM
Last Name:CHUKWUNEKE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-4241
Mailing Address - Country:US
Mailing Address - Phone:646-354-7330
Mailing Address - Fax:347-602-5331
Practice Address - Street 1:392 E TREMONT AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453
Practice Address - Country:US
Practice Address - Phone:646-354-7330
Practice Address - Fax:347-602-5331
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist