Provider Demographics
NPI:1669562393
Name:CHIKEZIE, AUGUSTINE O (MD)
Entity type:Individual
Prefix:DR
First Name:AUGUSTINE
Middle Name:O
Last Name:CHIKEZIE
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 1:6712 WASHINGTON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-1999
Mailing Address - Country:US
Mailing Address - Phone:609-641-1155
Mailing Address - Fax:609-641-1140
Practice Address - Street 1:6712 WASHINGTON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08234-1999
Practice Address - Country:US
Practice Address - Phone:609-641-1155
Practice Address - Fax:609-641-1140
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA059781002080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001799258Medicaid
OH2306294Medicaid
NY02192749Medicaid
MD1203011Medicaid
NJ7848803Medicaid
0372969ROTMedicare PIN
H14242Medicare UPIN
NY02192749Medicaid