Provider Demographics
NPI:1982840781
Name:NWACHUKWU, LONGINUS NLEMADIM (PT, PHD)
Entity Type:Individual
Prefix:DR
First Name:LONGINUS
Middle Name:NLEMADIM
Last Name:NWACHUKWU
Suffix:
Gender:M
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1394 SCHENECTADY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-6532
Mailing Address - Country:US
Mailing Address - Phone:718-801-7486
Mailing Address - Fax:718-282-4639
Practice Address - Street 1:1394 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-6532
Practice Address - Country:US
Practice Address - Phone:718-801-7486
Practice Address - Fax:718-282-4639
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist