Provider Demographics
NPI:1851596696
Name:ONWUBALILI, NDIDIAMAKA (MD)
Entity Type:Individual
Prefix:DR
First Name:NDIDIAMAKA
Middle Name:
Last Name:ONWUBALILI
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 1:89 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1946
Mailing Address - Country:US
Mailing Address - Phone:973-761-5600
Mailing Address - Fax:973-761-5100
Practice Address - Street 1:89 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1946
Practice Address - Country:US
Practice Address - Phone:973-761-5600
Practice Address - Fax:973-761-5100
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08394600207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22-1965397OtherDIAMOND INSTITUTE FOR INFERTILITY AND MENOPAUSE
NCRES00000Medicare UPIN