Healthcare Provider Details

I. General information

NPI: 1740549203
Provider Name (Legal Business Name): NWANKWO G MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 UNION AVE STE 105
IRVINGTON NJ
07111-5574
US

IV. Provider business mailing address

22 UNION AVE
IRVINGTON NJ
07111-5574
US

V. Phone/Fax

Practice location:
  • Phone: 973-416-1111
  • Fax: 973-416-4133
Mailing address:
  • Phone: 973-416-1111
  • Fax: 973-416-4133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GLORIA O NWANKWO
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 973-416-4111