1063777928 NPI number — MRS. NKECHI C. IROKU B.SC.,M.SC.EDU, ETC.

Table of content: MRS. NKECHI C. IROKU B.SC.,M.SC.EDU, ETC. (NPI 1063777928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063777928 NPI number — MRS. NKECHI C. IROKU B.SC.,M.SC.EDU, ETC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IROKU
Provider First Name:
NKECHI
Provider Middle Name:
C.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
B.SC.,M.SC.EDU, ETC.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ILOPUTAIFE
Provider Other First Name:
NKECHI
Provider Other Middle Name:
C.
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063777928
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121-46 GRAYSON STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD GARDENS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-406-8362
Provider Business Mailing Address Fax Number:
718-527-2386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12146 GRAYSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD GARDENS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11413-1038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-406-8362
Provider Business Practice Location Address Fax Number:
718-527-2386
Provider Enumeration Date:
07/06/2012

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: 174400000X , 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)

  • Identifier: 0673894 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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