Healthcare Provider Details

I. General information

NPI: 1740127646
Provider Name (Legal Business Name): TOCHUKWU GERALD EMMANUEL IJEOMAH MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79-01 BROADWAY, ROOM C10-12 79-01 BROADWAY, ROOM C10-12
ELMHURST NY
11373
US

IV. Provider business mailing address

79-01 BROADWAY, ROOM C10-12
ELMHURST NY
11373
US

V. Phone/Fax

Practice location:
  • Phone: 718-334-3542
  • Fax:
Mailing address:
  • Phone: 718-334-3542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: