Provider Demographics
NPI:1598789141
Name:IZEOGU, CHINWEIKE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHINWEIKE
Middle Name:
Last Name:IZEOGU
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 1:290 S LIVINGSTON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3986
Mailing Address - Country:US
Mailing Address - Phone:973-533-0954
Mailing Address - Fax:973-533-0958
Practice Address - Street 1:290 S LIVINGSTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3986
Practice Address - Country:US
Practice Address - Phone:973-533-0954
Practice Address - Fax:973-533-0958
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235169207LP2900X
NJ25MA08075700207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY235169OtherNEW YORK STATE OFFICE OF THE PROFESSIONS