Provider Demographics
NPI:1982966677
Name:OGBONNA, CHIDI IRENE (MS (SPECIAL ED))
Entity Type:Individual
Prefix:
First Name:CHIDI
Middle Name:IRENE
Last Name:OGBONNA
Suffix:
Gender:F
Credentials:MS (SPECIAL ED)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 BRADFORD ST
Mailing Address - Street 2:APT. 2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-5902
Mailing Address - Country:US
Mailing Address - Phone:347-365-8790
Mailing Address - Fax:347-365-8790
Practice Address - Street 1:561 BRADFORD ST
Practice Address - Street 2:APT. 2F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-5902
Practice Address - Country:US
Practice Address - Phone:347-365-8790
Practice Address - Fax:347-365-8790
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-09
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY571673174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY78086OtherNYSDOH