Healthcare Provider Details

I. General information

NPI: 1396958310
Provider Name (Legal Business Name): CHUKWUEMEKA ONYEDIKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 11/23/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 DOREEN DR
STATEN ISLAND NY
10303-2136
US

IV. Provider business mailing address

21 DOREEN DR
STATEN ISLAND NY
10303-2136
US

V. Phone/Fax

Practice location:
  • Phone: 929-661-7383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number272520
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: