Healthcare Provider Details

I. General information

NPI: 1770102469
Provider Name (Legal Business Name): NNAEMEKA ANTHONY NWEKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

161 SUSSEX AVE
NEWARK NJ
07103
US

V. Phone/Fax

Practice location:
  • Phone: 214-799-3412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberV8351
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: