Provider Demographics
NPI:1740549203
Name:NWANKWO G MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:NWANKWO G MEDICAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:O
Authorized Official - Last Name:NWANKWO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-416-4111
Mailing Address - Street 1:22 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-5574
Mailing Address - Country:US
Mailing Address - Phone:973-416-1111
Mailing Address - Fax:973-416-4133
Practice Address - Street 1:22 UNION AVE STE 105
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-5574
Practice Address - Country:US
Practice Address - Phone:973-416-1111
Practice Address - Fax:973-416-4133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8638900Medicaid
NJ8638900Medicaid