Provider Demographics
NPI:1710059530
Name:OJUGBELI, IFECHUKWUDE ONYEOBA (MD)
Entity Type:Individual
Prefix:DR
First Name:IFECHUKWUDE
Middle Name:ONYEOBA
Last Name:OJUGBELI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 GENESEE STREET
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-1707
Mailing Address - Country:US
Mailing Address - Phone:315-687-6467
Mailing Address - Fax:315-251-2240
Practice Address - Street 1:304 GENESEE STREET
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037-1707
Practice Address - Country:US
Practice Address - Phone:315-687-6467
Practice Address - Fax:315-251-2240
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209777 1207R00000X
NY209777207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01729982Medicaid
BB5400Medicare ID - Type Unspecified
NY01729982Medicaid