Healthcare Provider Details

I. General information

NPI: 1275975880
Provider Name (Legal Business Name): EMMANUEL UZOMA NWOGU D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HOSPITAL DR
MASSENA NY
13662-1037
US

IV. Provider business mailing address

1 HOSPITAL DR
MASSENA NY
13662-1056
US

V. Phone/Fax

Practice location:
  • Phone: 315-769-4638
  • Fax: 315-842-3099
Mailing address:
  • Phone: 315-769-4200
  • Fax: 315-842-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number264234
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: