Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 176905 | NY |
Y | 111NI0900X | Internist | 176905 | NY |
N | 207RN0300X | Nephrologist | 176905 | NY |
NPI | 1073551966 |
---|---|
Provider Name | Onyekachi Ifudu |
First Address | Westbury, NY 11590-1132 |
Second Address | Brooklyn, NY 11230-6801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 19/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01172229 | (05) | NY |
E98536 | (02) |