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General NPI Number Information
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NPI Number | 1205612678
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Entity Type | Individual
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Provider Name | BENNETH IFEYANYI MEKOBA APN
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Gender | Male
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Dates
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Enumeration Date | 09/01/2023
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 1203 W ST GEORGE AVE
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City | LINDEN
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State | NJ
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Zip | 07036
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Country | US
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Telephone | 908-583-5151
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Fax |
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Provider Business Mailing Address
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Address Line | 586 WOODSIDE AVE
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City | ROSELLE
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State | NJ
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Zip | 07203
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Country | US
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Telephone | 973-495-7914
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ14895300
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License Number State | NJ
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