Provider Demographics
NPI:1366295545
Name:CHUKWUMEZIE, NKEM B
Entity type:Individual
Prefix:DR
First Name:NKEM
Middle Name:B
Last Name:CHUKWUMEZIE
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:PO BOX 200645
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-0645
Mailing Address - Country:US
Mailing Address - Phone:412-860-8445
Mailing Address - Fax:347-894-8949
Practice Address - Street 1:21451 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1733
Practice Address - Country:US
Practice Address - Phone:347-894-8949
Practice Address - Fax:347-894-8949
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2551L001251J00000X, 376J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251J00000XAgenciesNursing Care
No376J00000XNursing Service Related ProvidersHomemaker