Healthcare Provider Details

I. General information

NPI: 1962240069
Provider Name (Legal Business Name): MR. CASIMIR U AKUNNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MYRTLE AVE
PLAINFIELD NJ
07063-1000
US

IV. Provider business mailing address

1700 MYRTLE AVE
PLAINFIELD NJ
07063-1000
US

V. Phone/Fax

Practice location:
  • Phone: 908-753-6401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15005200
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: