Provider Demographics
NPI:1356701544
Name:EKWUEME, AZUKAEGO
Entity type:Individual
Prefix:
First Name:AZUKAEGO
Middle Name:
Last Name:EKWUEME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 SAINT JOHNS PL
Mailing Address - Street 2:SUITE E4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2550
Mailing Address - Country:US
Mailing Address - Phone:347-998-4683
Mailing Address - Fax:
Practice Address - Street 1:1045 SAINT JOHNS PL
Practice Address - Street 2:SUITE E4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2550
Practice Address - Country:US
Practice Address - Phone:347-998-4683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver