Provider Demographics
NPI:1043605272
Name:GOGOH, ONWEREMADU
Entity Type:Individual
Prefix:MR
First Name:ONWEREMADU
Middle Name:
Last Name:GOGOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4825
Mailing Address - Country:US
Mailing Address - Phone:917-586-3572
Mailing Address - Fax:
Practice Address - Street 1:650 E 221ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5110
Practice Address - Country:US
Practice Address - Phone:917-586-3572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY438375475347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle