Healthcare Provider Details

I. General information

NPI: 1912437997
Provider Name (Legal Business Name): OGORI N KALU MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2017
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 APT 3C
SOUTH ORANGE NJ
07079-1064
US

V. Phone/Fax

Practice location:
  • Phone: 973-877-2963
  • Fax: 973-877-2824
Mailing address:
  • Phone: 646-247-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number25MA08831300
License Number StateNJ

VIII. Authorized Official

Name: VALERIE DEL VECCHIO
Title or Position: BILLING AGENT
Credential:
Phone: 973-687-7720