Healthcare Provider Details

I. General information

NPI: 1992942676
Provider Name (Legal Business Name): OGORI N KALU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 DR MARTIN LUTHER KING JR BLVD
NEWARK NJ
07102-2011
US

IV. Provider business mailing address

609 W SOUTH ORANGE AVE
SOUTH ORANGE NJ
07079-1063
US

V. Phone/Fax

Practice location:
  • Phone: 973-877-2770
  • Fax:
Mailing address:
  • Phone: 646-247-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA108986
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number247698
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number25MA08831300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: