Healthcare Provider Details

I. General information

NPI: 1730145194
Provider Name (Legal Business Name): OSAHON UKPONMWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 CENTRAL PARK AVE SUITE 3P
YONKERS NY
10710-4905
US

IV. Provider business mailing address

1730 CENTRAL PARK AVE SUITE 3P
YONKERS NY
10710-4905
US

V. Phone/Fax

Practice location:
  • Phone: 914-779-0141
  • Fax: 914-779-0144
Mailing address:
  • Phone: 914-779-0141
  • Fax: 914-779-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number173320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: