Healthcare Provider Details

I. General information

NPI: 1740578715
Provider Name (Legal Business Name): MR. OBIOMA ANDERSON NWOKEOHURU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 MAYOR GIBSON BLVD STE 606
NEWARK NJ
07102-4537
US

IV. Provider business mailing address

724 WHARFSIDE CT BLDG 70A
PERTH AMBOY NJ
08861-2999
US

V. Phone/Fax

Practice location:
  • Phone: 201-822-1161
  • Fax:
Mailing address:
  • Phone: 718-866-8963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15232700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: