Basic Information
| Provider Information | |||||||||
| NPI: | 1225044985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IHENACHO | ||||||||
| FirstName: | GLORIA | ||||||||
| MiddleName: | IJEOMA | ||||||||
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| Credential: | M. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 LIBERTY AVE | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073074021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5513589459 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 POLY PL | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112097104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188366600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207R00000X | 236910 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.