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General NPI Number Information
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NPI Number | 1982182895
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Entity Type | Individual
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Provider Name | MR. EMMANUEL OSZWA ODIGIE
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Gender | Male
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 148-13 HILLSIDE AVE, 2ND FL BRIARWOOD
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City | BRIARWOOD
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State | NY
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Zip | 11435
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Country | US
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Telephone | 347-238-1435
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Fax | 347-960-8403
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Provider Business Mailing Address
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Address Line | 148-13 HILLSIDE AVE, 2ND FL BRIARWOOD
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City | BRIARWOOD
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State | NY
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Zip | 11435
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Country | US
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Telephone | 347-238-1435
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Fax | 347-960-8403
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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 | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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