Healthcare Provider Details

I. General information

NPI: 1932082955
Provider Name (Legal Business Name): CHIGOLUM OKIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11675 232ND ST
CAMBRIA HEIGHTS NY
11411-1833
US

IV. Provider business mailing address

11675 232ND ST
CAMBRIA HEIGHTS NY
11411-1833
US

V. Phone/Fax

Practice location:
  • Phone: 347-658-8236
  • Fax:
Mailing address:
  • Phone: 347-658-8236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number970329
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: