Provider Demographics
NPI:1902471642
Name:MOMAH, KENECHUKWU (MD)
Entity Type:Individual
Prefix:
First Name:KENECHUKWU
Middle Name:
Last Name:MOMAH
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:BRONXCARE HEALTH SYSTEM, 1650 SELWYN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457
Mailing Address - Country:US
Mailing Address - Phone:718-960-1416
Mailing Address - Fax:718-518-5124
Practice Address - Street 1:1650 SELWYN AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-960-1416
Practice Address - Fax:718-518-5124
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program