Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 063115 | NJ |
Y | 208000000X | Pediatrician | MA63115 | NJ |
N | 2080P0204X | Pediatric Emergency Doctor | MA63115 | NJ |
NPI | 1205842408 |
---|---|
Provider Name | Stephen Amaefuna |
First Address | West Orange, NJ 07052-2652 |
Second Address | West Orange, NJ 07052-2652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 01/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7177402 | (05) | NJ |
G12464 | (02) |