1730307224 NPI number — DR. COLLINS OLUCHI CHILAKA MD

Table of content: DR. COLLINS OLUCHI CHILAKA MD (NPI 1730307224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730307224 NPI number — DR. COLLINS OLUCHI CHILAKA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHILAKA
Provider First Name:
COLLINS
Provider Middle Name:
OLUCHI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1730307224
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1918 FIRST AVENUE DRAPPER HALL
Provider Second Line Business Mailing Address:
9W10
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10029-7405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-579-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 E 149TH ST
Provider Second Line Business Practice Location Address:
LINCOLN MEDICAL AND MENTAL CENTER
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10451-5504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-579-5874
Provider Business Practice Location Address Fax Number:
718-579-4836
Provider Enumeration Date:
04/23/2007

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: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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