1104436021 NPI number — UCHECHUKWUKA OSADEBE M.D., PLLC

Table of content: (NPI 1104436021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104436021 NPI number — UCHECHUKWUKA OSADEBE M.D., PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UCHECHUKWUKA OSADEBE M.D., PLLC
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:
UCHE OSADEBE M.D.
Provider Other Organization Name Type Code:
3
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:
1104436021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 2ND ST APT 605
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JERSEY CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07302-6100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-859-2054
Provider Business Mailing Address Fax Number:
888-920-1521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 BROADWAY STE 1800
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:
10006-1652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-517-4271
Provider Business Practice Location Address Fax Number:
888-920-1521
Provider Enumeration Date:
08/05/2020

Additional Information

Authorized Official

Authorized Official Last Name:
OSADEBE
Authorized Official First Name:
UCHECHUKWUKA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
832-859-2054

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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