Provider Demographics
NPI:1376695643
Name:UKOH, INI ASUKWO (RPAC)
Entity Type:Individual
Prefix:
First Name:INI
Middle Name:ASUKWO
Last Name:UKOH
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 KINGS DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-5225
Mailing Address - Country:US
Mailing Address - Phone:845-692-5073
Mailing Address - Fax:845-692-5073
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:LINCOLN HOSPITAL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-6027
Practice Address - Fax:718-579-6060
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY005249363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical