Healthcare Provider Details

I. General information

NPI: 1174433650
Provider Name (Legal Business Name): ABUMCHUKWU ONUJIOGU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 GLEN ST STE 14
STOUGHTON MA
02072-2481
US

IV. Provider business mailing address

27 GLEN ST STE 14
STOUGHTON MA
02072-2481
US

V. Phone/Fax

Practice location:
  • Phone: 631-522-7416
  • Fax:
Mailing address:
  • Phone: 631-522-7416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN10007280
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: