Provider Demographics
NPI:1861121873
Name:ACHOAKAWA, PRINCE UBA
Entity type:Individual
Prefix:
First Name:PRINCE
Middle Name:UBA
Last Name:ACHOAKAWA
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 1:45 S VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-1214
Mailing Address - Country:US
Mailing Address - Phone:917-968-9607
Mailing Address - Fax:
Practice Address - Street 1:45 S VILLAGE DR
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-1214
Practice Address - Country:US
Practice Address - Phone:917-968-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028455363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant