Provider Demographics
NPI:1689750861
Name:ECHEZONA, OKECHUKWU SAMUEL (MD)
Entity Type:Individual
Prefix:MR
First Name:OKECHUKWU
Middle Name:SAMUEL
Last Name:ECHEZONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:82-64 164TH STREET
Mailing Address - Street 2:1B-02
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-883-3070
Mailing Address - Fax:718-883-6115
Practice Address - Street 1:8264 164TH STREET
Practice Address - Street 2:1B-02
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-883-3070
Practice Address - Fax:718-883-6115
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY266238207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00246075Medicaid
NY00246075Medicaid