Healthcare Provider Details

I. General information

NPI: 1093651473
Provider Name (Legal Business Name): NATHANIEL UKO-IMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 SIMONSON PL STE 1402
STATEN ISLAND NY
10302-1816
US

IV. Provider business mailing address

96 SIMONSON PL STE 1402
STATEN ISLAND NY
10302-1816
US

V. Phone/Fax

Practice location:
  • Phone: 347-681-0922
  • Fax:
Mailing address:
  • Phone: 347-681-0922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberP141296
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: