Healthcare Provider Details

I. General information

NPI: 1962148940
Provider Name (Legal Business Name): MICHAEL C ENECHUKWU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 ROUTE 70 E BLDG A
MARLTON NJ
08053-2341
US

IV. Provider business mailing address

335A HUNTERDON ST
NEWARK NJ
07103-2599
US

V. Phone/Fax

Practice location:
  • Phone: 856-983-3900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA12639000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: