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General NPI Number Information
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NPI Number | 1396707584
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Entity Type | Individual
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Provider Name | ADOLPHUS CHUKWUGOZIE ANOSIKE O,D.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 820 FLATBUSH AVE
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City | BROOKLYN
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State | NY
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Zip | 11226-3102
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Country | US
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Telephone | 718-693-5994
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Fax | 718-693-6284
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Provider Business Mailing Address
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Address Line | 117 79TH ST
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City | NORTH BERGEN
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State | NJ
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Zip | 07047-5839
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Country | US
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Telephone | 201-295-0892
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV004752-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OAOO472300
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License Number State | NJ
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