MEDICARE: MR. MATHEW UCHENNA AJEMBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F406700-01	NY

General Provider Information

NPI Number	:	1740095405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATHEW UCHENNA AJEMBA

Provider Business Mailing Address
First Line	:	26 NEDS WAY
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-7522
Country	:	US
Telephone Number	:	516-451-0277
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 NEDS WAY
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-7522
Country	:	US
Telephone Number	:	516-451-0277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2025
Last Update Date	:	02/10/2025

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