Healthcare Provider Details

I. General information

NPI: 1619190816
Provider Name (Legal Business Name): UCHENNA CHRISTIAN NWOBU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BERGEN ST
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

140 BERGEN ST
NEWARK NJ
07103-2425
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-2700
  • Fax: 973-972-2739
Mailing address:
  • Phone: 973-972-2700
  • Fax: 973-972-2739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number259463
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License Number25MA09302700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA09302700
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2009-00608
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: