Healthcare Provider Details

I. General information

NPI: 1033217294
Provider Name (Legal Business Name): OBIANULO ROSE ONYEMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 STEVENS AVE SUITE 207
MT VERNON NY
10550-2686
US

IV. Provider business mailing address

105 STEVENS AVE SUITE 207
MT VERNON NY
10550-2686
US

V. Phone/Fax

Practice location:
  • Phone: 914-665-3309
  • Fax: 914-665-2736
Mailing address:
  • Phone: 914-665-3309
  • Fax: 914-665-2736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNY178995
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: