Provider Demographics
NPI:1225448996
Name:OSADEBE, UCHECHUKWUKA (MD)
Entity type:Individual
Prefix:
First Name:UCHECHUKWUKA
Middle Name:
Last Name:OSADEBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296042208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice