Provider Demographics
NPI:1720077944
Name:AJA-ONU, IHEANYICHUKWU (MD)
Entity Type:Individual
Prefix:
First Name:IHEANYICHUKWU
Middle Name:
Last Name:AJA-ONU
Suffix:
Gender:M
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:PO BOX 37216
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-7216
Mailing Address - Country:US
Mailing Address - Phone:516-623-5076
Mailing Address - Fax:516-623-0312
Practice Address - Street 1:3 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-2218
Practice Address - Country:US
Practice Address - Phone:516-623-5076
Practice Address - Fax:516-623-5076
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203413207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01956665Medicaid
NY01956665Medicaid
NY59N501Medicare ID - Type Unspecified