Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 25MA05827100 | NJ |
Y | 2080P0203X | Pediatric Critical Care Doctor | 25MA05827100 | NJ |
NPI | 1134129570 |
---|---|
Provider Name | Okechukwu P. Anene |
First Address | Edison, NJ 08820-3947 |
Second Address | Edison, NJ 08820-3947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 15/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7474008 | (05) | NJ |
G50013 | (02) |