Healthcare Provider Details

I. General information

NPI: 1164735296
Provider Name (Legal Business Name): NONSO EKENE ENEKWECHI M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 BROADWAY FL 8
NEW YORK NY
10027-7164
US

IV. Provider business mailing address

2920 BROADWAY FL 8
NEW YORK NY
10027-7164
US

V. Phone/Fax

Practice location:
  • Phone: 212-854-2878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number270020
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: