Healthcare Provider Details

I. General information

NPI: 1962008367
Provider Name (Legal Business Name): UCHECHI OGBONNAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 OLD BERGEN RD
JERSEY CITY NJ
07305-2297
US

IV. Provider business mailing address

265 OLD BERGEN RD
JERSEY CITY NJ
07305-2297
US

V. Phone/Fax

Practice location:
  • Phone: 914-320-2742
  • Fax:
Mailing address:
  • Phone: 914-320-2742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number805587
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: