Healthcare Provider Details

I. General information

NPI: 1578012746
Provider Name (Legal Business Name): CHIKA OJEYEMI PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/02/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BROADWAY
NEW YORK NY
10004-1303
US

IV. Provider business mailing address

11 BROADWAY STE 1168
NEW YORK NY
10004-1326
US

V. Phone/Fax

Practice location:
  • Phone: 212-320-2216
  • Fax:
Mailing address:
  • Phone: 212-320-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberF405804-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number715546
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: