Healthcare Provider Details

I. General information

NPI: 1821040767
Provider Name (Legal Business Name): EMMANUEL CHUKWUDUM NWOKEDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9507 SEAVIEW AVE
BROOKLYN NY
11236-5431
US

IV. Provider business mailing address

9507 SEAVIEW AVE
BROOKLYN NY
11236-5431
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-3605
  • Fax: 718-630-2857
Mailing address:
  • Phone: 718-630-3605
  • Fax: 718-630-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number236098
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: