Provider Demographics
NPI:1629062419
Name:NWACHUKWU, IHUOMA N (MD)
Entity Type:Individual
Prefix:DR
First Name:IHUOMA
Middle Name:N
Last Name:NWACHUKWU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 WEST GILBERT STREET
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4918
Mailing Address - Country:US
Mailing Address - Phone:732-212-0060
Mailing Address - Fax:
Practice Address - Street 1:155 JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1706
Practice Address - Country:US
Practice Address - Phone:973-589-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06248800207P00000X, 207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6948308Medicaid
NJP00652890OtherRAILROAD MEDICARE
NJ01000040103OtherAMERICHOICE
NJ891997UXLMedicare PIN
NJ891997DLEMedicare PIN
NJ6948308Medicaid
NJ891997UWYMedicare PIN
NJ891997DPHMedicare PIN
NJG35604Medicare UPIN
NJ891997UXKMedicare PIN
NJ891997UWXMedicare PIN
NJP00652890OtherRAILROAD MEDICARE
NJ891997DPKMedicare PIN
NJ891997XZMMedicare PIN