Provider Demographics
NPI:1659678142
Name:DIVINE LOVE MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:DIVINE LOVE MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMAKA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:UZOIGWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-425-1849
Mailing Address - Street 1:9502 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-2016
Mailing Address - Country:US
Mailing Address - Phone:347-425-1849
Mailing Address - Fax:347-240-1505
Practice Address - Street 1:9502 FOSTER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-2016
Practice Address - Country:US
Practice Address - Phone:347-425-1849
Practice Address - Fax:347-240-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243076208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY033042094Medicaid