Provider Demographics
NPI:1063728947
Name:ANIUKWU, JIDEOFOR (MD, PHD)
Entity type:Individual
Prefix:
First Name:JIDEOFOR
Middle Name:
Last Name:ANIUKWU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 E 83RD ST APT 12D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4339
Mailing Address - Country:US
Mailing Address - Phone:917-386-7199
Mailing Address - Fax:
Practice Address - Street 1:353 E 83RD ST APT 12D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4339
Practice Address - Country:US
Practice Address - Phone:917-386-7199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275619208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery