Provider Demographics
NPI:1740606359
Name:MOMAH, ONYEDIKACHUKWU K (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ONYEDIKACHUKWU
Middle Name:K
Last Name:MOMAH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:548 THRONGS NECK EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465
Mailing Address - Country:US
Mailing Address - Phone:631-875-4169
Mailing Address - Fax:866-644-0894
Practice Address - Street 1:548 THRONGS NECK EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465
Practice Address - Country:US
Practice Address - Phone:631-875-4169
Practice Address - Fax:866-644-0894
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056764363AS0400X
NY122219103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)