Provider Demographics
NPI:1073726907
Name:EDEDET AKPAN UDO, MD, PC
Entity Type:Organization
Organization Name:EDEDET AKPAN UDO, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDEDET
Authorized Official - Middle Name:AKPAN
Authorized Official - Last Name:UDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-375-2226
Mailing Address - Street 1:18 SHONNARD PL
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2411
Mailing Address - Country:US
Mailing Address - Phone:914-375-2226
Mailing Address - Fax:
Practice Address - Street 1:2601 FREDRICK DOUGLASS BLVD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030
Practice Address - Country:US
Practice Address - Phone:212-234-3433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202225207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH56174Medicare UPIN
NYWCW021Medicare ID - Type Unspecified