Healthcare Provider Details

I. General information

NPI: 1992880215
Provider Name (Legal Business Name): EBERECHI NWAOBASI-IWUH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE DEPT OF PEDIATRICS
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

99 BEAUVOIR AVE DEPT OF PEDIATRICS
SUMMIT NJ
07901-3533
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-5870
  • Fax: 908-522-4066
Mailing address:
  • Phone: 908-522-5870
  • Fax: 908-522-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA074979
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: