Healthcare Provider Details

I. General information

NPI: 1427687623
Provider Name (Legal Business Name): CHIOMA A IKEDIONWU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 E 53RD ST FL 4
NEW YORK NY
10022-4602
US

IV. Provider business mailing address

159 E 53RD ST FL 4
NEW YORK NY
10022-4602
US

V. Phone/Fax

Practice location:
  • Phone: 646-754-2700
  • Fax: 646-754-9803
Mailing address:
  • Phone: 646-754-2700
  • Fax: 646-754-9803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number331620
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: