Kalu Ndu Boniface Agwu, MD

Key facts

NPI

1104840032

Entity type

Individual (NPI type 1)

Primary specialty

Geriatric Psychiatry Physician 2084P0805X

License

237607 (NY)

Practice address

506 Lenox Ave
Harlem Hospital
New York, NY 10037-2206

Phone

(212) 939-1000

NPI assigned

Jul 26, 2006

Sex

Male

Sole proprietor

Yes

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Physician Affiliate Group of New York PC Registered Dietitian · New York, NY · NPI 1013375526
  Medicare reassignment Care Compare group NPD NY
• Harlem Medical Associates PC General Practice Physician · New York, NY · NPI 1487957692
  Medicare reassignment NPD NY
• Metropolitan Medical Practice Plan PC General Practice Physician · New York, NY · NPI 1306138383
  Medicare reassignment NPD NY
• Downstate Mental Hygiene Associates Public Health or Welfare Agency · Brooklyn, NY · NPI 1386678373
  NPD (past)
• Medical Healthcare Services P.C. Psychiatry Physician · New York, NY · NPI 1427342658
  NPD (past)
• Psychiatry and Psychotherapy Practice P.C. Psychiatry Physician · New York, NY · NPI 1548298508
  NPD (past)

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• New York City Health and Hospitals Corporation General Acute Care Hospital · New York, NY · NPI 1033124961
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Psychiatry

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physician Affiliate Group of New York PC (1,222 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Harlem Hospital Center Hospital · New York, NY · CCN 330240

Medicare participation

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

Practice roles (6 of 10)

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359

Specialties & licenses

Addresses

Other identifiers

Other names

• Dr. Kalu Ndu Boniface Agwu Other name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 26, 2015.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427328000000",
    "number": "1104840032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 WOODFIELD RD",
            "city": "POMONA",
            "state": "NY",
            "postal_code": "109702216",
            "telephone_number": "917-744-0371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 LENOX AVE",
            "address_2": "HARLEM HOSPITAL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100372206",
            "telephone_number": "212-939-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGWU",
        "first_name": "KALU",
        "middle_name": "NDU BONIFACE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2015-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "NY",
            "license": "237607",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK STATE LICENSE",
            "identifier": "237607",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KALU",
            "last_name": "AGWU",
            "middle_name": "NDU BONIFACE",
            "prefix": "DR.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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