Healthcare Provider Details

I. General information

NPI: 1275899064
Provider Name (Legal Business Name): CLEMENT O OJEVWE REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 WHITE PLAINS RD
BRONX NY
10467-8106
US

IV. Provider business mailing address

2303 WHITE PLAINS RD
BRONX NY
10467-8106
US

V. Phone/Fax

Practice location:
  • Phone: 718-655-5515
  • Fax: 718-408-3255
Mailing address:
  • Phone: 718-655-5515
  • Fax: 718-408-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number604685
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: