Provider Demographics
NPI:1104436021
Name:UCHECHUKWUKA OSADEBE M.D., PLLC
Entity type:Organization
Organization Name:UCHECHUKWUKA OSADEBE M.D., PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UCHECHUKWUKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSADEBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-859-2054
Mailing Address - Street 1:3 SOMERSET LN APT 412
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-2422
Mailing Address - Country:US
Mailing Address - Phone:832-859-2054
Mailing Address - Fax:888-920-1521
Practice Address - Street 1:4142 COLLEGE POINT BLVD STE 2A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4386
Practice Address - Country:US
Practice Address - Phone:646-517-4271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty