Provider Demographics
NPI:1336223825
Name:UDE WELCOME, AKUEZUNKPA OLIAKU (MD)
Entity Type:Individual
Prefix:
First Name:AKUEZUNKPA
Middle Name:OLIAKU
Last Name:UDE WELCOME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 1ST AVE
Mailing Address - Street 2:NBV 15N1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-6509
Mailing Address - Fax:212-263-8640
Practice Address - Street 1:550 1ST AVE
Practice Address - Street 2:NBV 15N1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-6509
Practice Address - Fax:212-263-8640
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY217119208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02587882Medicaid
NYI16822Medicare UPIN
NY02587882Medicaid