Provider Demographics
NPI:1144024399
Name:IGHODARO, OSARENMWINDA
Entity type:Individual
Prefix:
First Name:OSARENMWINDA
Middle Name:
Last Name:IGHODARO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DEER PATH DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-2001
Mailing Address - Country:US
Mailing Address - Phone:518-728-2825
Mailing Address - Fax:
Practice Address - Street 1:19 DEER PATH DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-2001
Practice Address - Country:US
Practice Address - Phone:518-728-2825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26219LY344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi