Provider Demographics
NPI:1467408047
Name:NKWONTA, JOYCE (MD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:NKWONTA
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 1:1314 PARK AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3253
Mailing Address - Country:US
Mailing Address - Phone:908-561-9733
Mailing Address - Fax:908-561-8944
Practice Address - Street 1:1314 PARK AVE
Practice Address - Street 2:STE 1
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3253
Practice Address - Country:US
Practice Address - Phone:908-561-9733
Practice Address - Fax:908-561-8944
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07088700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8499101Medicaid
G53176Medicare UPIN
NJ8499101Medicaid