Healthcare Provider Details

I. General information

NPI: 1649134487
Provider Name (Legal Business Name): KELECHI NGWOBIA UKA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4152 BOYD AVE
BRONX NY
10466-2026
US

IV. Provider business mailing address

4152 BOYD AVE
BRONX NY
10466-2026
US

V. Phone/Fax

Practice location:
  • Phone: 347-961-7787
  • Fax:
Mailing address:
  • Phone: 347-961-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: