Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 25MA06938100 | NJ |
N | 2086S0129X | Vascular Surgeon | MAO6965500 | NJ |
NPI | 1043261001 |
---|---|
Provider Name | Obi J Imegwu |
First Address | Somerville, NJ 08876-2500 |
Second Address | Somerville, NJ 08876-2500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 13/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
048738BP7 | (02) | NJ |
8500304 | (05) | NJ |
F90785 | (02) |