Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 284434 | NY |
Y | 111NI0900X | Internist | 284434 | NY |
N | 207RG0300X | Geriatric Medicine | 284434 | NY |
NPI | 1093031056 |
---|---|
Provider Name | Mr. Ifeanyi Chika Oguagha |
First Address | Arverne, NY 11692-1409 |
Second Address | Arverne, NY 11692-1409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2010 |
Last Update Date | 24/07/2020 |