Provider Demographics
NPI:1992455323
Name:MGBEOJIRIKWE, JESSICA ONYEKA (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ONYEKA
Last Name:MGBEOJIRIKWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SAINT ANDREWS LN
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2254
Mailing Address - Country:US
Mailing Address - Phone:516-674-7631
Mailing Address - Fax:
Practice Address - Street 1:167 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3637
Practice Address - Country:US
Practice Address - Phone:631-909-6262
Practice Address - Fax:332-210-7730
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY328737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program