Provider Demographics
NPI:1417103417
Name:OBIEFUNA, NKECHINYERE ANGELA (MD)
Entity Type:Individual
Prefix:DR
First Name:NKECHINYERE
Middle Name:ANGELA
Last Name:OBIEFUNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 FOREST HAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-6316
Mailing Address - Country:US
Mailing Address - Phone:732-710-1214
Mailing Address - Fax:
Practice Address - Street 1:1920 FOREST HAVEN BLVD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-6316
Practice Address - Country:US
Practice Address - Phone:732-710-1214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08456700208M00000X
GA76919207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0209155Medicaid
NJP00768133OtherRAILROAD MEDICARE
NJ0209155Medicaid