Healthcare Provider Details

I. General information

NPI: 1215630124
Provider Name (Legal Business Name): JUDE AKPEDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 MERRICK RD
OCEANSIDE NY
11572-1420
US

IV. Provider business mailing address

2315 CROPSEY AVE APT B5
BROOKLYN NY
11214-5747
US

V. Phone/Fax

Practice location:
  • Phone: 516-255-8414
  • Fax: 516-255-8453
Mailing address:
  • Phone: 347-469-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: