Healthcare Provider Details

I. General information

NPI: 1790672947
Provider Name (Legal Business Name): NNEKA GLORIA EKEJIUBA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8268 164TH ST
JAMAICA NY
11432-1104
US

IV. Provider business mailing address

1434 REMSEN AVE
BROOKLYN NY
11236-4768
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-3000
  • Fax:
Mailing address:
  • Phone: 929-272-4805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number892500-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: