Healthcare Provider Details

I. General information

NPI: 1588527618
Provider Name (Legal Business Name): VITAL CARE WELLNESS NP IN ADULT HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21726 138TH RD
SPRINGFIELD GARDENS NY
11413-2608
US

IV. Provider business mailing address

21726 138TH RD
SPRINGFIELD GARDENS NY
11413-2608
US

V. Phone/Fax

Practice location:
  • Phone: 845-288-0988
  • Fax: 718-808-0043
Mailing address:
  • Phone: 845-288-0988
  • Fax: 718-808-0043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OBIOMA ONAH
Title or Position: PRESIDENT
Credential: DNP
Phone: 347-393-5187