Provider Demographics
NPI:1023059722
Name:IBEKU, CHUKWUEMEKA (MD)
Entity type:Individual
Prefix:
First Name:CHUKWUEMEKA
Middle Name:
Last Name:IBEKU
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:PO BOX 861
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-0861
Mailing Address - Country:US
Mailing Address - Phone:908-686-9440
Mailing Address - Fax:908-686-9445
Practice Address - Street 1:940 STUYVESANT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6906
Practice Address - Country:US
Practice Address - Phone:908-686-9440
Practice Address - Fax:908-686-9445
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA072747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0022381Medicaid
066849SQRMedicare PIN
NJ0022381Medicaid
H48066Medicare UPIN
NJ066849TLMMedicare PIN