Provider Demographics
NPI:1134595374
Name:ONYEIZU, REXMARIA O (NPN)
Entity type:Individual
Prefix:
First Name:REXMARIA
Middle Name:O
Last Name:ONYEIZU
Suffix:
Gender:F
Credentials:NPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 NOEL RD
Mailing Address - Street 2:
Mailing Address - City:BROAD CHANNEL
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1042
Mailing Address - Country:US
Mailing Address - Phone:347-599-3600
Mailing Address - Fax:
Practice Address - Street 1:DOE
Practice Address - Street 2:42-09 28TH STREET
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:347-599-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY605401163W00000X
NYF382781363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse