Provider Demographics
NPI:1518443662
Name:EGBUKWU, TOOCHUKWU ONYINYE
Entity Type:Individual
Prefix:
First Name:TOOCHUKWU
Middle Name:ONYINYE
Last Name:EGBUKWU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 SPRUCE ST STE 159
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4115
Mailing Address - Country:US
Mailing Address - Phone:215-858-4135
Mailing Address - Fax:
Practice Address - Street 1:3720 SPRUCE ST STE 159
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4115
Practice Address - Country:US
Practice Address - Phone:215-858-4135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA34653601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health