Provider Demographics
NPI:1720602691
Name:CHUKWUKA S MORDI, NP PSYCHIATRY PC
Entity Type:Organization
Organization Name:CHUKWUKA S MORDI, NP PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PSYCHIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUKWUKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORDI
Authorized Official - Suffix:
Authorized Official - Credentials:FPMHNP
Authorized Official - Phone:347-693-4311
Mailing Address - Street 1:32 N MONTAGUE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3708
Mailing Address - Country:US
Mailing Address - Phone:347-693-4311
Mailing Address - Fax:
Practice Address - Street 1:24101 NEWHALL AVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2408
Practice Address - Country:US
Practice Address - Phone:347-693-4311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty