Provider Demographics
NPI:1841235033
Name:UDO, EMEFRE OSCAR-AMANAM (MD)
Entity Type:Individual
Prefix:DR
First Name:EMEFRE
Middle Name:OSCAR-AMANAM
Last Name:UDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 CHURCH AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4195
Mailing Address - Country:US
Mailing Address - Phone:718-352-0083
Mailing Address - Fax:718-627-1525
Practice Address - Street 1:2244 CHURCH AVE FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4195
Practice Address - Country:US
Practice Address - Phone:718-352-0083
Practice Address - Fax:718-627-1525
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02439581Medicaid
NY03799373Medicaid
NYA100001474OtherPTAN
NY1456P1Medicare ID - Type Unspecified
NYA100001474OtherPTAN