Provider Demographics
NPI:1326324179
Name:ENYIA, GODSON IHUOMA
Entity Type:Individual
Prefix:MR
First Name:GODSON
Middle Name:IHUOMA
Last Name:ENYIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#2 PARK AVE
Mailing Address - Street 2:YONKERS SERVICE CENTER
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703
Mailing Address - Country:US
Mailing Address - Phone:914-969-0543
Mailing Address - Fax:914-969-3643
Practice Address - Street 1:#2 PARK AVE
Practice Address - Street 2:YONKERS SERVICE CENTER
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703
Practice Address - Country:US
Practice Address - Phone:914-969-0543
Practice Address - Fax:914-969-3643
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY484071163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health