MEDICARE: MR. JONATHAN NDUKAKU IHEROBIEM

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
1	253Z00000X	In Home Supportive Care Agency		NJ

General Provider Information

NPI Number	:	1962364356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN NDUKAKU IHEROBIEM

Provider Business Mailing Address
First Line	:	93 CALDWELL PL
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-1731
Country	:	US
Telephone Number	:	862-233-5299
Fax Number	:

Provider Business Practice Location Address
First Line	:	93 CALDWELL PL
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-1731
Country	:	US
Telephone Number	:	862-233-5922
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	11/24/2025

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