Healthcare Provider Details

I. General information

NPI: 1104487891
Provider Name (Legal Business Name): HENRY O NWAZURUOKEH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 TAYLOR RD
CHESAPEAKE VA
23321-2246
US

IV. Provider business mailing address

755 MEMORIAL PKWY STE 300
PHILLIPSBURG NJ
08865-2748
US

V. Phone/Fax

Practice location:
  • Phone: 757-738-1600
  • Fax: 757-465-8616
Mailing address:
  • Phone: 908-847-3300
  • Fax: 908-847-2889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102207106
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: