Healthcare Provider Details

I. General information

NPI: 1013361229
Provider Name (Legal Business Name): EFFY AMONDY OJUOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 GRANDVIEW AVE STE B
WATERBURY CT
06708-2514
US

IV. Provider business mailing address

87 GRANDVIEW AVE STE B
WATERBURY CT
06708-2514
US

V. Phone/Fax

Practice location:
  • Phone: 203-574-2020
  • Fax:
Mailing address:
  • Phone: 203-574-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number67661
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: