Healthcare Provider Details

I. General information

NPI: 1275220733
Provider Name (Legal Business Name): NKAFU BECHEM NDEMAZIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 BARD AVE DEPT OF
STATEN ISLAND NY
10310-1664
US

IV. Provider business mailing address

355 BARD AVE DEPT OF
STATEN ISLAND NY
10310-1664
US

V. Phone/Fax

Practice location:
  • Phone: 718-818-2419
  • Fax:
Mailing address:
  • Phone: 718-818-2419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.156103
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: