Provider Demographics
NPI:1326289984
Name:ANUKWUEM ENTERPRISES, INC
Entity Type:Organization
Organization Name:ANUKWUEM ENTERPRISES, INC
Other - Org Name:LCT MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIDI
Authorized Official - Middle Name:I
Authorized Official - Last Name:ANUKWUEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-399-2600
Mailing Address - Street 1:1182 STUYVESANT AVE
Mailing Address - Street 2:FL. 1
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1057
Mailing Address - Country:US
Mailing Address - Phone:973-399-2600
Mailing Address - Fax:973-399-5252
Practice Address - Street 1:1182 STUYVESANT AVE
Practice Address - Street 2:FL. 1
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1057
Practice Address - Country:US
Practice Address - Phone:973-399-2600
Practice Address - Fax:973-399-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA058920261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6135102Medicaid
NJAN763128Medicare PIN
NJ6135102Medicaid