Provider Demographics
NPI:1952349532
Name:LIFECARE FAMILY DOCTORS, PC
Entity Type:Organization
Organization Name:LIFECARE FAMILY DOCTORS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHUKWUEMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:IBEKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-686-9440
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ078791Medicare PIN