Provider Demographics
NPI:1083912158
Name:ODIAH, NNAMDI EMMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:NNAMDI
Middle Name:EMMANUEL
Last Name:ODIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CARMAN AVE
Mailing Address - Street 2:APT 2H
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1147
Mailing Address - Country:US
Mailing Address - Phone:646-623-0582
Mailing Address - Fax:
Practice Address - Street 1:200 CARMAN AVE
Practice Address - Street 2:APT 2H
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1147
Practice Address - Country:US
Practice Address - Phone:646-623-0582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2603782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry