Provider Demographics
NPI:1437490380
Name:UMOH, UDUAK GODWIN
Entity Type:Individual
Prefix:MRS
First Name:UDUAK
Middle Name:GODWIN
Last Name:UMOH
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 1:4143 MURDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2113
Mailing Address - Country:US
Mailing Address - Phone:718-715-1024
Mailing Address - Fax:718-715-1024
Practice Address - Street 1:4143 MURDOCK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2113
Practice Address - Country:US
Practice Address - Phone:718-715-1024
Practice Address - Fax:718-715-1024
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY528565-1163W00000X, 163WS0200X, 251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163W00000XNursing Service ProvidersRegistered Nurse
No251300000XAgenciesLocal Education Agency (LEA)