Provider Demographics
NPI:1205869765
Name:ANYANWU, ANELECHI CHINEDU (MD)
Entity type:Individual
Prefix:
First Name:ANELECHI
Middle Name:CHINEDU
Last Name:ANYANWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 5TH AVE
Mailing Address - Street 2:BOX 1028
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6503
Mailing Address - Country:US
Mailing Address - Phone:212-659-6811
Mailing Address - Fax:212-659-6818
Practice Address - Street 1:1190 5TH AVE
Practice Address - Street 2:BOX 1028
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6503
Practice Address - Country:US
Practice Address - Phone:212-659-6811
Practice Address - Fax:212-659-6818
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002611208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02826740Medicaid
NY02826740Medicaid