Provider Demographics
NPI:1225448996
Name:OSADEBE, UCHECHUKWUKA (MD)
Entity Type:Individual
Prefix:
First Name:UCHECHUKWUKA
Middle Name:
Last Name:OSADEBE
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 1:159 2ND ST APT 605
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-6100
Mailing Address - Country:US
Mailing Address - Phone:832-859-2054
Mailing Address - Fax:888-920-1521
Practice Address - Street 1:115 BROADWAY STE 1800
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1652
Practice Address - Country:US
Practice Address - Phone:646-517-4271
Practice Address - Fax:888-920-1521
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296042208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice