Provider Demographics
NPI:1104840032
Name:AGWU, KALU NDU BONIFACE (MD)
Entity Type:Individual
Prefix:DR
First Name:KALU
Middle Name:NDU BONIFACE
Last Name:AGWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KALU
Other - Middle Name:NDU BONIFACE
Other - Last Name:AGWU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:37 WOODFIELD RD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2216
Mailing Address - Country:US
Mailing Address - Phone:917-744-0371
Mailing Address - Fax:
Practice Address - Street 1:506 LENOX AVE
Practice Address - Street 2:HARLEM HOSPITAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-2206
Practice Address - Country:US
Practice Address - Phone:212-939-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2376072084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY237607OtherNEW YORK STATE LICENSE