Provider Demographics
NPI:1962364356
Name:IHEROBIEM, JONATHAN NDUKAKU
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:NDUKAKU
Last Name:IHEROBIEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 CALDWELL PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1731
Mailing Address - Country:US
Mailing Address - Phone:862-233-5299
Mailing Address - Fax:
Practice Address - Street 1:93 CALDWELL PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1731
Practice Address - Country:US
Practice Address - Phone:862-233-5922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care