Provider Demographics
NPI:1578605812
Name:ONYENSO, CHIKEZIE (MD)
Entity Type:Individual
Prefix:
First Name:CHIKEZIE
Middle Name:
Last Name:ONYENSO
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 1:34 UNION AVE FL 2
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:862-772-3976
Mailing Address - Fax:862-849-2156
Practice Address - Street 1:34 UNION AVE FL 2
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:862-772-3976
Practice Address - Fax:862-849-2156
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA058822208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ806665UZHMedicare PIN
NJG19627Medicare UPIN
NJ6922309Medicaid