Provider Demographics
NPI:1134601008
Name:OHRIALA, IJEOMA RUBI
Entity type:Individual
Prefix:MRS
First Name:IJEOMA
Middle Name:RUBI
Last Name:OHRIALA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:IJEOMA
Other - Middle Name:
Other - Last Name:OHRIALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19120 115TH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2708
Mailing Address - Country:US
Mailing Address - Phone:347-592-8958
Mailing Address - Fax:
Practice Address - Street 1:19120 115TH RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2708
Practice Address - Country:US
Practice Address - Phone:347-592-8958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331215101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty