Provider Demographics
NPI:1487235271
Name:HARDY, OWUZECHI JESSIE (MD)
Entity type:Individual
Prefix:DR
First Name:OWUZECHI
Middle Name:JESSIE
Last Name:HARDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:70 ELLIOT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2310
Mailing Address - Country:US
Mailing Address - Phone:774-381-9345
Mailing Address - Fax:
Practice Address - Street 1:ELMHURST HOSPITAL CENTER
Practice Address - Street 2:79-01 BROADWAY
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:781-334-3542
Practice Address - Fax:718-334-3441
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084932312084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
08493231Other08493231