Provider Demographics
NPI:1386803989
Name:EKULIDE, EMMANUEL NEBECHUKWU (MD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:NEBECHUKWU
Last Name:EKULIDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:626 VARSITY ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2652
Mailing Address - Country:US
Mailing Address - Phone:973-762-6311
Mailing Address - Fax:973-327-4601
Practice Address - Street 1:43 PROGRESS STREET
Practice Address - Street 2:SUBURBAN TREATMENT ASSOCIATES
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083
Practice Address - Country:US
Practice Address - Phone:908-687-7188
Practice Address - Fax:908-687-0294
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03447200207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine