Provider Demographics
NPI:1508981598
Name:CHINYERE OFONAGORO PHYSICIAN PLLC
Entity Type:Organization
Organization Name:CHINYERE OFONAGORO PHYSICIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINYERE
Authorized Official - Middle Name:
Authorized Official - Last Name:OFONAGORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-668-3950
Mailing Address - Street 1:22 W 1ST ST
Mailing Address - Street 2:SUITE 314
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-3000
Mailing Address - Country:US
Mailing Address - Phone:914-668-3950
Mailing Address - Fax:914-668-3950
Practice Address - Street 1:22 W 1ST ST
Practice Address - Street 2:SUITE 314
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3000
Practice Address - Country:US
Practice Address - Phone:914-668-3950
Practice Address - Fax:914-668-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01922123Medicaid
NYWDW671Medicare ID - Type Unspecified
NY01922123Medicaid