Provider Demographics
NPI:1033217294
Name:ONYEMA, OBIANULO ROSE (MD)
Entity Type:Individual
Prefix:
First Name:OBIANULO
Middle Name:ROSE
Last Name:ONYEMA
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 1:105 STEVENS AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2686
Mailing Address - Country:US
Mailing Address - Phone:914-665-3309
Mailing Address - Fax:914-665-2736
Practice Address - Street 1:105 STEVENS AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:MT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2686
Practice Address - Country:US
Practice Address - Phone:914-665-3309
Practice Address - Fax:914-665-2736
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY178995208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01197593Medicaid