Organization
MAIN STREET KIDNEY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IHEANYICHUKWU AJA-ONU MD (CEO)
(516) 623-5076
Entity
Organization
Contact information
Practice address
3 N MAIN ST, FREEPORT, NY 11520-2218
(516) 623-5076
Mailing address
PO BOX 37216, ELMONT, NY 11003-7216
(516) 623-5076
(516) 623-0312
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Enumeration date
03/29/2021
Last updated
03/29/2021
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