Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 40QA01928900 | NJ |
Y | 225100000X | Physical Therapist | 40QA01928900 | NJ |
NPI | 1013532084 |
---|---|
Provider Name | Kennedy U. Chukwuocha |
First Address | Moorestown, NJ 08057-4602 |
Second Address | Delran, NJ 08075-1869 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2020 |
Last Update Date | 21/10/2020 |