Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 25MA03447200 | NJ |
NPI | 1386803989 |
---|---|
Provider Name | Emmanuel Nebechukwu Ekulide |
First Address | South Orange, NJ 07079-2652 |
Second Address | Union, NJ 07083 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 09/06/2008 |