Provider Demographics
NPI:1467503235
Name:EKEKE, EMMANUEL UKWUOMA
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:UKWUOMA
Last Name:EKEKE
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 1:12813 145TH ST
Mailing Address - Street 2:APT 2
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1822
Mailing Address - Country:US
Mailing Address - Phone:917-855-2299
Mailing Address - Fax:
Practice Address - Street 1:12813 145TH ST
Practice Address - Street 2:APT 2
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11436-1822
Practice Address - Country:US
Practice Address - Phone:917-855-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY482750367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered