1457109191 NPI number — CHIDERA MARIANNE NWOBU DMD

Table of content: CHIDERA MARIANNE NWOBU DMD (NPI 1457109191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457109191 NPI number — CHIDERA MARIANNE NWOBU DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NWOBU
Provider First Name:
CHIDERA
Provider Middle Name:
MARIANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457109191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 RAPPLEYE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST ORANGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07052-2194
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
862-438-0051
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 E ALLEGHENY AVE FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134-4427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-282-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)