Provider Demographics
NPI:1518063551
Name:ILOGU, NOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:
Last Name:ILOGU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CLYDE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5032
Mailing Address - Country:US
Mailing Address - Phone:732-247-9001
Mailing Address - Fax:732-247-9002
Practice Address - Street 1:33 CLYDE RD
Practice Address - Street 2:STE 105
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5032
Practice Address - Country:US
Practice Address - Phone:732-247-9001
Practice Address - Fax:732-247-9002
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06645800207RA0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7993501Medicaid
NJ223638353OtherTAX ID
NJ462180488OtherTAX ID
NJ223638353OtherTAX ID
NJ008952P7XMedicare ID - Type Unspecified