Healthcare Provider Details

I. General information

NPI: 1124983473
Provider Name (Legal Business Name): CHINOMSO EKANEM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

953 E 241ST ST APT 1R
BRONX NY
10466-1049
US

IV. Provider business mailing address

953 E 241ST ST APT 1R
BRONX NY
10466-1049
US

V. Phone/Fax

Practice location:
  • Phone: 646-626-9334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: