Provider Demographics
NPI:1013363951
Name:ONAH, OBIOMA
Entity type:Individual
Prefix:
First Name:OBIOMA
Middle Name:
Last Name:ONAH
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 1:21726 138TH RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2608
Mailing Address - Country:US
Mailing Address - Phone:718-772-7951
Mailing Address - Fax:718-808-0043
Practice Address - Street 1:1420 BUSHWICK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-1422
Practice Address - Country:US
Practice Address - Phone:718-772-7951
Practice Address - Fax:718-808-0043
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF310779363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY713291Medicaid