Healthcare Provider Details

I. General information

NPI: 1396350674
Provider Name (Legal Business Name): IKECHUKWU ONWEAGBA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2020
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 MADISON AVE
NEW YORK NY
10029-6542
US

IV. Provider business mailing address

1470 MADISON AVE
NEW YORK NY
10029-6542
US

V. Phone/Fax

Practice location:
  • Phone: 646-483-1436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF310007
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number597553
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: