Provider Demographics
NPI:1487719753
Name:ANUKWUEM, CHIDI IHEANACHO (MD)
Entity type:Individual
Prefix:DR
First Name:CHIDI
Middle Name:IHEANACHO
Last Name:ANUKWUEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 STUYVESANT AVE
Mailing Address - Street 2:FL. 1
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1057
Mailing Address - Country:US
Mailing Address - Phone:973-399-2600
Mailing Address - Fax:973-399-5252
Practice Address - Street 1:1182 STUYVESANT AVE
Practice Address - Street 2:FL. 1
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1057
Practice Address - Country:US
Practice Address - Phone:973-399-2600
Practice Address - Fax:973-399-5252
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA058920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6135102Medicaid
NJAN763128Medicare ID - Type Unspecified
NJ6135102Medicaid