Healthcare Provider Details

I. General information

NPI: 1720602691
Provider Name (Legal Business Name): CHUKWUKA S MORDI, NP PSYCHIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24101 NEWHALL AVE
ROSEDALE NY
11422-2408
US

IV. Provider business mailing address

32 N MONTAGUE ST
VALLEY STREAM NY
11580-3708
US

V. Phone/Fax

Practice location:
  • Phone: 347-693-4311
  • Fax:
Mailing address:
  • Phone: 347-693-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CHUKWUKA MORDI
Title or Position: DIRECTOR OF PSYCHIATRY
Credential: FPMHNP
Phone: 347-693-4311