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NPI Code Detail

MEDICARE: DR. NNENNA OBIANUJU EZECHUKWU DDS

MEDICARE: DR. NNENNA OBIANUJU EZECHUKWU DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist103324-875WI
2122300000XDentist058123NY

General Provider Information

NPI Number : 1558737692
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NNENNA OBIANUJU EZECHUKWU DDS
Provider Business Mailing Address
First Line : 6200 BEACH CHANNEL DR
Second Line :
City : ARVERNE
State : NY
Zip : 11692-1409
Country : US
Telephone Number : 718-945-7150
Fax Number : 718-945-2596
Provider Business Practice Location Address
First Line : 6200 BEACH CHANNEL DR
Second Line :
City : ARVERNE
State : NY
Zip : 11692-1409
Country : US
Telephone Number : 718-945-7150
Fax Number : 718-945-2596
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2015
Last Update Date : 12/12/2025

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