Healthcare Provider Details

I. General information

NPI: 1568428449
Provider Name (Legal Business Name): EDWIN AMOBI NJOKU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 BURNSIDE AVE
EAST HARTFORD CT
06108-3537
US

IV. Provider business mailing address

589 BURNSIDE AVE
EAST HARTFORD CT
06108-3537
US

V. Phone/Fax

Practice location:
  • Phone: 860-528-8200
  • Fax: 860-622-0872
Mailing address:
  • Phone: 860-528-8200
  • Fax: 860-622-0869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number039145
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: