Healthcare Provider Details

I. General information

NPI: 1780978452
Provider Name (Legal Business Name): KELECHI NGWANGWA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2011
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 2ND AVE
BROOKLYN NY
11220-3599
US

IV. Provider business mailing address

3414 CHURCH AVE
BROOKLYN NY
11203-2714
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-7942
  • Fax:
Mailing address:
  • Phone: 718-630-2197
  • Fax: 718-940-2914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number272211-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: