Healthcare Provider Details

I. General information

NPI: 1275673907
Provider Name (Legal Business Name): CHIKA KUWAMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RIVER RD STE 214
EDGEWATER NJ
07020-1171
US

IV. Provider business mailing address

725 RIVER RD STE 214
EDGEWATER NJ
07020-1171
US

V. Phone/Fax

Practice location:
  • Phone: 201-581-8553
  • Fax: 201-270-0257
Mailing address:
  • Phone: 201-581-8553
  • Fax: 201-270-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA07665000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: