Provider Demographics
NPI:1295922276
Name:KUBEYINJE, NIKE ITOHAN (MD)
Entity type:Individual
Prefix:
First Name:NIKE
Middle Name:ITOHAN
Last Name:KUBEYINJE
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 1:785 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1673
Mailing Address - Country:US
Mailing Address - Phone:860-523-4100
Mailing Address - Fax:860-523-1462
Practice Address - Street 1:785 FARMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1673
Practice Address - Country:US
Practice Address - Phone:860-523-4100
Practice Address - Fax:860-523-1462
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD036800207P00000X
NY272823208000000X
FLME108550208000000X
CT55255208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003200300Medicaid