Provider Demographics
NPI:1043261001
Name:IMEGWU, OBI J (MD)
Entity type:Individual
Prefix:
First Name:OBI
Middle Name:J
Last Name:IMEGWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 REHILL AVENUE
Mailing Address - Street 2:SUITE 3400
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2500
Mailing Address - Country:US
Mailing Address - Phone:908-725-2400
Mailing Address - Fax:908-927-8990
Practice Address - Street 1:30 REHILL AVENUE
Practice Address - Street 2:SUITE 3400
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2500
Practice Address - Country:US
Practice Address - Phone:908-725-2400
Practice Address - Fax:908-927-8990
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMAO69655002086S0129X
NJ25MA069381002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8500304Medicaid
F90785Medicare UPIN
NJ048738BP7Medicare UPIN