Healthcare Provider Details

I. General information

NPI: 1689427080
Provider Name (Legal Business Name): JUSTICE CHIEBUKA MGBECHETA MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 07/25/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 READE PLACE
POUGHKEEPSIE NY
12601-3990
US

IV. Provider business mailing address

45 READE PLACE
POUGHKEEPSIE NY
12601-3990
US

V. Phone/Fax

Practice location:
  • Phone: 845-790-1301
  • Fax:
Mailing address:
  • Phone:
  • 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: