Simon Ibezimchi Udemgba, PH.D.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

005435 Issued in NY

Practice address

401 New Karner Rd
Brandon Place
Albany, NY 12205-3840

Phone

(518) 456-3614

NPI assigned

Jan 30, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369958400000",
    "number": "1043582646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 MICHIGAN AVE",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123031313",
            "telephone_number": "518-374-5336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 NEW KARNER RD",
            "address_2": "BRANDON PLACE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122053840",
            "telephone_number": "518-456-3614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UDEMGBA",
        "first_name": "SIMON",
        "middle_name": "IBEZIMCHI",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-01-30",
        "last_updated": "2013-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "005435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS OFFICE OF PROFESSIONS",
            "identifier": "005435",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carole J Tygert, RN
• Danielle Tyler, PA-C
• Jordan M Tymeson
• Stephanie Tyndale, LPN
• Colleen F. Tyson, CRNA
• Emily Marie Uebbing, PHARMD
• Richard L Uhl, M.D.
• Kenechukwu H Ukeje, MD
• Arfa Ul-Haque
• Asad Ullah, M.D.

• Mental Health Counselor in Albany, NY
• Providers in Albany, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.