Organization
NOVA VITA MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
UBONG JACKSON UDOYEN (MD)
(203) 870-1616
Entity
Organization
Contact information
Practice address
3180 MAIN ST, BRIDGEPORT, CT 06606
(203) 870-1616
(203) 870-1615
Mailing address
3180 MAIN ST, BRIDGEPORT, CT 06606-4237
(203) 870-1616
(203) 870-1615
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
50553
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50553
STATE LICENSE
CT
Enumeration date
11/13/2017
Last updated
06/16/2018
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