Provider Demographics
NPI:1679764823
Name:ACHOLONU, UCHENNA CLETUS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:UCHENNA
Middle Name:CLETUS
Last Name:ACHOLONU
Suffix:JR
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 95000-2243
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2243
Mailing Address - Country:US
Mailing Address - Phone:516-338-5300
Mailing Address - Fax:516-338-1075
Practice Address - Street 1:1090 AMSTERDAM AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1737
Practice Address - Country:US
Practice Address - Phone:212-636-1130
Practice Address - Fax:212-636-1133
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY245177207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02925006Medicaid
NY245177-1OtherNYS LICENSE
NYFA0421280OtherDEA
NY154541U991Medicare PIN