Healthcare Provider Details

I. General information

NPI: 1134743446
Provider Name (Legal Business Name): NWAKILE IZUCHUKWU OJIKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY
BROOKLYN NY
11206-5317
US

IV. Provider business mailing address

760 BROADWAY
BROOKLYN NY
11206-5317
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-5807
  • Fax: 718-302-7382
Mailing address:
  • Phone: 718-963-5807
  • Fax: 718-302-7382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA12640800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25MA12640800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: