Provider Demographics
NPI:1750853800
Name:IGWEATU, OBYAGELI (ANYIKWA , IGWEATU)
Entity Type:Individual
Prefix:MRS
First Name:OBYAGELI
Middle Name:
Last Name:IGWEATU
Suffix:
Gender:F
Credentials:ANYIKWA , IGWEATU
Other - Prefix:MS
Other - First Name:OBYAGELI
Other - Middle Name:
Other - Last Name:ANYIKWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 ANDOVER CT
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-3174
Mailing Address - Country:US
Mailing Address - Phone:609-903-5246
Mailing Address - Fax:
Practice Address - Street 1:458 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08609-2711
Practice Address - Country:US
Practice Address - Phone:609-903-5246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ131226017162632172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver