Healthcare Provider Details

I. General information

NPI: 1700492436
Provider Name (Legal Business Name): NNAMDI UWAKWE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 01/29/2022
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5546 BROADWAY
BRONX NY
10463-5250
US

IV. Provider business mailing address

931 E 174TH ST
BRONX NY
10460-5226
US

V. Phone/Fax

Practice location:
  • Phone: 917-688-4590
  • Fax:
Mailing address:
  • Phone: 917-310-3371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF343466-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: