Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 051169 | NY |
N | 213EG0000X | General Practice | 051169 | NY |
Y | 1223P0700X | Prosthodontist | 22DI02314900 | NJ |
N | 1223P0700X | Prosthodontist | DS036867 | PA |
NPI | 1083715734 |
---|---|
Provider Name | Dr. Elochukwu Adibe |
First Address | Lansdale, PA 19446-6710 |
Second Address | Monroe Township, NJ 08831-6820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 04/12/2019 |