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General NPI Number Information
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NPI Number | 1639586845
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Entity Type | Individual
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Provider Name | UGOCHUKWU UKONU
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Gender | Male
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 188 E BERGEN PL STE 302
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City | RED BANK
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State | NJ
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Zip | 07701
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Country | US
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Telephone | 732-219-6620
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Fax | 732-219-6225
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Provider Business Mailing Address
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Address Line | 1135 MORTON ST
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City | MATTAPAN
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State | MA
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Zip | 02126-2834
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Country | US
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Telephone | 312-778-6306
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 274346-224
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MB10071500
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License Number State | NJ
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