Provider Demographics
NPI:1992880215
Name:NWAOBASI-IWUH, EBERECHI (MD)
Entity type:Individual
Prefix:
First Name:EBERECHI
Middle Name:
Last Name:NWAOBASI-IWUH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 BEAUVOIR AVE
Mailing Address - Street 2:DEPT OF PEDIATRICS
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3533
Mailing Address - Country:US
Mailing Address - Phone:908-522-5870
Mailing Address - Fax:908-522-4066
Practice Address - Street 1:99 BEAUVOIR AVE
Practice Address - Street 2:DEPT OF PEDIATRICS
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3533
Practice Address - Country:US
Practice Address - Phone:908-522-5870
Practice Address - Fax:908-522-4066
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA074979208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0039632Medicaid
NJ107905A0ZMedicare PIN