Healthcare Provider Details

I. General information

NPI: 1245739341
Provider Name (Legal Business Name): DR. EMA UKO-ABASI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 DWIGHT RD STE 102
LONGMEADOW MA
01106-1768
US

IV. Provider business mailing address

171 DWIGHT RD STE 102
LONGMEADOW MA
01106-1768
US

V. Phone/Fax

Practice location:
  • Phone: 413-824-4070
  • Fax:
Mailing address:
  • Phone: 413-824-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23783
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2358169
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: