Provider Demographics
NPI:1740843770
Name:UFOMBA, JOY C
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:C
Last Name:UFOMBA
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 1:1137 E 224TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-5834
Mailing Address - Country:US
Mailing Address - Phone:718-798-3630
Mailing Address - Fax:347-945-4686
Practice Address - Street 1:435 E 5TH ST STE 2
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-2004
Practice Address - Country:US
Practice Address - Phone:718-798-3630
Practice Address - Fax:347-945-4686
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04781742Medicaid