Basic Information
| Provider Information | |||||||||
| NPI: | 1336223825 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UDE WELCOME | ||||||||
| FirstName: | AKUEZUNKPA | ||||||||
| MiddleName: | OLIAKU | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 1ST AVE | ||||||||
| Address2: | NBV 15N1 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100166402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122636509 | ||||||||
| FaxNumber: | 2122638640 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 1ST AVE | ||||||||
| Address2: | NBV 15N1 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100166402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122636509 | ||||||||
| FaxNumber: | 2122638640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 217119 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 02587882 | 05 | NY | MEDICAID |