Provider Demographics
NPI:1750698478
Name:ADVANTAGE MEDICAL CONSULTANTS PC
Entity type:Organization
Organization Name:ADVANTAGE MEDICAL CONSULTANTS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINWEIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:IZEOGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-224-1100
Mailing Address - Street 1:631 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3846
Mailing Address - Country:US
Mailing Address - Phone:201-437-8600
Mailing Address - Fax:
Practice Address - Street 1:631 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3846
Practice Address - Country:US
Practice Address - Phone:201-437-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08075700208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty