1326129339 NPI number — NONYELU IRUOMA ANYICHIE M.D.

Table of content: NONYELU IRUOMA ANYICHIE M.D. (NPI 1326129339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326129339 NPI number — NONYELU IRUOMA ANYICHIE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANYICHIE
Provider First Name:
NONYELU
Provider Middle Name:
IRUOMA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1326129339
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:
WESTSIDE NEW YORK MEDICAL PC
Provider Second Line Business Mailing Address:
PO BOX 45
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10034-0045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-531-9900
Provider Business Mailing Address Fax Number:
888-422-9813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 STEVENS AVE STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10550-2682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-699-7700
Provider Business Practice Location Address Fax Number:
888-422-9813
Provider Enumeration Date:
10/17/2006

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: 207V00000X , with the licence number:  222949 , 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)