Healthcare Provider Details

I. General information

NPI: 1376695643
Provider Name (Legal Business Name): INI ASUKWO UKOH RPAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST LINCOLN HOSPITAL
BRONX NY
10451-5504
US

IV. Provider business mailing address

6 KINGS DR
MIDDLETOWN NY
10941-5225
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-6027
  • Fax: 718-579-6060
Mailing address:
  • Phone: 845-692-5073
  • Fax: 845-692-5073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number005249
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: