1073726907 NPI number — EDEDET AKPAN UDO, MD, PC

Table of content: (NPI 1073726907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073726907 NPI number — EDEDET AKPAN UDO, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDEDET AKPAN UDO, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073726907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 SHONNARD PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10703-2411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-375-2226
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 FREDRICK DOUGLASS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-234-3433
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
UDO
Authorized Official First Name:
EDEDET
Authorized Official Middle Name:
AKPAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
914-375-2226

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  202225 , 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)