Basic Information
| Provider Information | |||||||||
| NPI: | 1386805448 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UWEMEDIMO | ||||||||
| FirstName: | OMOLARA | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., M.P.H | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11316 FRANCIS LEWIS BLVD | ||||||||
| Address2: | |||||||||
| City: | QUEENS VILLAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114292214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9175824084 | ||||||||
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| Practice Location | |||||||||
| Address1: | 622 W 168TH ST | ||||||||
| Address2: | VANDERBILT CLINIC 4TH FLOOR - ROOM 402 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123056227 | ||||||||
| FaxNumber: | 2123058819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2008 | ||||||||
| LastUpdateDate: | 03/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 245288 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.