# NOVA VITA MEDICAL PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760907166
- **Authorized official:** UBONG JACKSON UDOYEN (MD)
- **Authorized official phone:** (803) 269-7381

## Contact information

- **Practice address:** 887 RUTLAND RD, BROOKLYN, NY 11203
- **Practice address phone:** (347) 627-6385
- **Practice address fax:** (347) 413-9888
- **Mailing address:** 887 RUTLAND RD, BROOKLYN, NY 11203-1911
- **Mailing address phone:** (347) 627-6385
- **Mailing address fax:** (347) 413-9888

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | — | NULL | Yes |
| 207K00000X | Allergy & Immunology Physician | — | — | Yes |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 08/07/2017
- **Last updated:** 05/22/2018