Provider Demographics
NPI:1710200837
Name:OGBONNAYA, EMMANUEL CHUKWUEMEKA (LPN)
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:CHUKWUEMEKA
Last Name:OGBONNAYA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BEECH CT
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524
Mailing Address - Country:US
Mailing Address - Phone:646-996-5911
Mailing Address - Fax:
Practice Address - Street 1:2753 SEXTON PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5203
Practice Address - Country:US
Practice Address - Phone:646-996-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296512164W00000X
NY655546163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY296512OtherLPN LICENSE