Provider Demographics
NPI:1831595396
Name:WORTHINGTON, CHINEZE IGBOECHI (MD)
Entity type:Individual
Prefix:MRS
First Name:CHINEZE
Middle Name:IGBOECHI
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHINEZE
Other - Middle Name:
Other - Last Name:IGBOECHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1028 BUSHWICK AVE
Mailing Address - Street 2:APT 4A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-4353
Mailing Address - Country:US
Mailing Address - Phone:773-677-8217
Mailing Address - Fax:
Practice Address - Street 1:317 E 17TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3804
Practice Address - Country:US
Practice Address - Phone:212-420-2742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY2974222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program