Provider Demographics
NPI:1467510776
Name:TOTAL SUPPORT MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:TOTAL SUPPORT MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CHIKEZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYENSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-373-0903
Mailing Address - Street 1:34 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3219
Mailing Address - Country:US
Mailing Address - Phone:973-373-0903
Mailing Address - Fax:973-373-1087
Practice Address - Street 1:34 UNION AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3219
Practice Address - Country:US
Practice Address - Phone:973-373-0903
Practice Address - Fax:973-373-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ097621Medicare ID - Type Unspecified
NJ806665UZHMedicare PIN