Provider Demographics
NPI:1184046088
Name:EZENWA, CHINYERE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHINYERE
Middle Name:
Last Name:EZENWA
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 1:8879 CONNEMARA LN
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9515
Mailing Address - Country:US
Mailing Address - Phone:716-816-8947
Mailing Address - Fax:
Practice Address - Street 1:2605 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4018
Practice Address - Country:US
Practice Address - Phone:716-816-8947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275928207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine