Healthcare Provider Details

I. General information

NPI: 1275459216
Provider Name (Legal Business Name): JANE NKECHI NWAFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 E GUN HILL RD
BRONX NY
10467-6107
US

IV. Provider business mailing address

147 GREENLAND DR
LANCASTER PA
17602-3385
US

V. Phone/Fax

Practice location:
  • Phone: 201-874-9084
  • Fax:
Mailing address:
  • Phone: 610-620-5381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberP137749
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: