Provider Demographics
NPI:1760582746
Name:ONWUZURUIGBO, CHUKWUEMEKA JOHN (MD)
Entity Type:Individual
Prefix:
First Name:CHUKWUEMEKA
Middle Name:JOHN
Last Name:ONWUZURUIGBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHUKS
Other - Middle Name:J
Other - Last Name:ONWU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3396
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-0019
Mailing Address - Country:US
Mailing Address - Phone:631-689-5384
Mailing Address - Fax:631-689-5396
Practice Address - Street 1:3771 NESCONSET HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1163
Practice Address - Country:US
Practice Address - Phone:631-689-5384
Practice Address - Fax:631-689-5396
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221837208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH34826Medicare UPIN
NYWEU891Medicare PIN
NY424I51Medicare PIN