Healthcare Provider Details

I. General information

NPI: 1134601008
Provider Name (Legal Business Name): MRS. IJEOMA RUBI OHRIALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. IJEOMA OHRIALA

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19120 115TH RD
SAINT ALBANS NY
11412-2708
US

IV. Provider business mailing address

19120 115TH RD
SAINT ALBANS NY
11412-2708
US

V. Phone/Fax

Practice location:
  • Phone: 347-592-8958
  • Fax:
Mailing address:
  • Phone: 347-592-8958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number331215
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: