Provider Demographics
NPI:1851853535
Name:UDEMBA, OKWUCHUKWU (PMHNP)
Entity type:Individual
Prefix:
First Name:OKWUCHUKWU
Middle Name:
Last Name:UDEMBA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 WEBSTER AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-5205
Mailing Address - Country:US
Mailing Address - Phone:347-271-7666
Mailing Address - Fax:
Practice Address - Street 1:1150 WEBSTER AVE STE 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-5205
Practice Address - Country:US
Practice Address - Phone:347-271-7666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF405802-01363LP0808X
NY766300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse