Provider Demographics
NPI:1538418397
Name:NWIGWE, CHUKWUEMEKA S (PT, DPT, OCS,FAAOMPT)
Entity type:Individual
Prefix:MR
First Name:CHUKWUEMEKA
Middle Name:S
Last Name:NWIGWE
Suffix:
Gender:M
Credentials:PT, DPT, OCS,FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2857
Mailing Address - Country:US
Mailing Address - Phone:973-327-7868
Mailing Address - Fax:
Practice Address - Street 1:349 VALLEY ST
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2857
Practice Address - Country:US
Practice Address - Phone:973-327-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41520225100000X
NJ40QA014647002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist