Provider Demographics
NPI:1619105483
Name:OKAFOR-MBAH GOMEZ, CHIOMA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHIOMA
Middle Name:
Last Name:OKAFOR-MBAH GOMEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHIOMA
Other - Middle Name:
Other - Last Name:OKAFOR-MBAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3251 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4509
Mailing Address - Country:US
Mailing Address - Phone:718-792-7600
Mailing Address - Fax:718-239-0182
Practice Address - Street 1:3251 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4509
Practice Address - Country:US
Practice Address - Phone:718-792-7600
Practice Address - Fax:718-239-0182
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY266343OtherLICENSE