Provider Demographics
NPI:1396840039
Name:NDUKA, IJEOMA N (MD)
Entity Type:Individual
Prefix:DR
First Name:IJEOMA
Middle Name:N
Last Name:NDUKA
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 1:175 MEMORIAL HWY
Mailing Address - Street 2:SUITE LL8
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5635
Mailing Address - Country:US
Mailing Address - Phone:914-235-7530
Mailing Address - Fax:914-235-8470
Practice Address - Street 1:175 MEMORIAL HWY
Practice Address - Street 2:SUITE LL8
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5635
Practice Address - Country:US
Practice Address - Phone:914-235-7530
Practice Address - Fax:914-235-8470
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189858207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01513928Medicaid
NYF39487Medicare UPIN
NY91K361Medicare ID - Type Unspecified