1053637975 NPI number — MRS. CHIOMA CHITURU EGBULEFU RPH

Table of content: MRS. CHIOMA CHITURU EGBULEFU RPH (NPI 1053637975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053637975 NPI number — MRS. CHIOMA CHITURU EGBULEFU RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EGBULEFU
Provider First Name:
CHIOMA
Provider Middle Name:
CHITURU
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARRAH
Provider Other First Name:
CHIOMA
Provider Other Middle Name:
CHITURU
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1053637975
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130-40 LAURELTON PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11422-1219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-869-9559
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130-40 LAURELTON PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11422-1219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-869-9559
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  048564 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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