Healthcare Provider Details

I. General information

NPI: 1720577042
Provider Name (Legal Business Name): UCHE NKIRU MOTANYA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E 124TH ST
NEW YORK NY
10035-1815
US

IV. Provider business mailing address

362 SAINT NICHOLAS AVE APT 1A
NEW YORK NY
10027-1896
US

V. Phone/Fax

Practice location:
  • Phone: 212-410-8100
  • Fax:
Mailing address:
  • Phone: 215-805-3140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD447
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN007409
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: