Basic Information
| Provider Information | |||||||||
| NPI: | 1104938687 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EMEKEKWUE | ||||||||
| FirstName: | NNEKA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 MYRTLE AVE | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070631000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087536401 | ||||||||
| FaxNumber: | 9087536401 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 MYRTLE AVE | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070631000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087536401 | ||||||||
| FaxNumber: | 9087536401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 02/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 22D102174400 | NJ | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | D08153500 | 01 | NJ | CDS | OTHER | BE8129391 | 01 | NJ | DEA | OTHER |