Provider Demographics
NPI:1821627597
Name:ACHONU, JUSTICE UZOMA
Entity Type:Individual
Prefix:
First Name:JUSTICE
Middle Name:UZOMA
Last Name:ACHONU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STONY BROOK MEDICINE HSC T-18 - 089
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8181
Mailing Address - Country:US
Mailing Address - Phone:631-444-1487
Mailing Address - Fax:631-444-3502
Practice Address - Street 1:STONY BROOK MEDICINE HSC T-18 - 089
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8181
Practice Address - Country:US
Practice Address - Phone:631-444-1487
Practice Address - Fax:631-444-3502
Is Sole Proprietor?:No
Enumeration Date:2020-04-05
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program