Provider Demographics
NPI:1134113939
Name:NWANKWO, GLORIA O (DO)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:O
Last Name:NWANKWO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 WEST GILBERT STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4918
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0052
Practice Address - Street 1:155 JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1706
Practice Address - Country:US
Practice Address - Phone:973-589-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07208100207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8638900Medicaid
NJP00411620OtherRAILROAD MEDICARE
NJ051738UXLMedicare PIN
NJ051738MK3Medicare PIN
NJ8638900Medicaid
NJ051738UXKMedicare PIN
NJH49677Medicare UPIN
NJ051738UWXMedicare PIN
NJ051738UWYMedicare PIN
NJ051738CLDMedicare PIN
NJP00411620OtherRAILROAD MEDICARE
NJ051738DPHMedicare PIN