Healthcare Provider Details

I. General information

NPI: 1821580101
Provider Name (Legal Business Name): CHINYERE KELECHI AGU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHINYERE KELECHI ARUNGWA MD

II. Dates (important events)

Enumeration Date: 06/03/2018
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 GEORGETOWN LN
BROOKLYN NY
11234-5742
US

IV. Provider business mailing address

32 GEORGETOWN LN
BROOKLYN NY
11234-5742
US

V. Phone/Fax

Practice location:
  • Phone: 347-978-6522
  • Fax:
Mailing address:
  • Phone: 347-978-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number316474
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: