Provider Demographics
NPI:1346338183
Name:UDEH, NKEM
Entity Type:Individual
Prefix:MRS
First Name:NKEM
Middle Name:
Last Name:UDEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 SAINT JOHNS PLACE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2645
Mailing Address - Country:US
Mailing Address - Phone:718-467-4600
Mailing Address - Fax:718-467-0075
Practice Address - Street 1:1162 SAINT JOHNS PLACE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2645
Practice Address - Country:US
Practice Address - Phone:718-467-4600
Practice Address - Fax:718-467-0075
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02445018Medicaid
4794550001Medicare ID - Type Unspecified