Provider Demographics
NPI:1679802318
Name:UDENTA, NWANNEKA C (OD)
Entity Type:Individual
Prefix:DR
First Name:NWANNEKA
Middle Name:C
Last Name:UDENTA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 BRINKERHOFF ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-2516
Mailing Address - Country:US
Mailing Address - Phone:201-486-4240
Mailing Address - Fax:
Practice Address - Street 1:625 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2169
Practice Address - Country:US
Practice Address - Phone:718-694-0076
Practice Address - Fax:718-694-0233
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007507152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist