Healthcare Provider Details

I. General information

NPI: 1124274386
Provider Name (Legal Business Name): MR. GODWIN N NJOKU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 MAIN ST SUITE 1
ONEONTA NY
13820
US

IV. Provider business mailing address

460 MAIN ST SUITE 1
ONEONTA NY
13820
US

V. Phone/Fax

Practice location:
  • Phone: 607-441-3300
  • Fax: 607-431-3305
Mailing address:
  • Phone: 607-441-3300
  • Fax: 607-441-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number249533
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: