Healthcare Provider Details

I. General information

NPI: 1639230600
Provider Name (Legal Business Name): JOYCE NKWONTA MD. PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 PARK AVE SUITE 1
PLAINFIELD NJ
07060-3253
US

IV. Provider business mailing address

1314 PARK AVE SUITE 1
PLAINFIELD NJ
07060-3253
US

V. Phone/Fax

Practice location:
  • Phone: 908-561-9733
  • Fax:
Mailing address:
  • Phone: 908-561-9733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA070887
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOYCE O NKWONTA
Title or Position: MD
Credential: M.D.
Phone: 908-561-9733