Provider Demographics
NPI:1043404635
Name:EBOIKPOMWEN, ABIEYUWA
Entity Type:Individual
Prefix:
First Name:ABIEYUWA
Middle Name:
Last Name:EBOIKPOMWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LENOX RD
Mailing Address - Street 2:APT 7K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2273
Mailing Address - Country:US
Mailing Address - Phone:786-488-1749
Mailing Address - Fax:
Practice Address - Street 1:404 W FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2437
Practice Address - Country:US
Practice Address - Phone:786-488-1749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2022-11-07
Deactivation Date:2009-08-31
Deactivation Code:
Reactivation Date:2012-08-24
Provider Licenses
StateLicense IDTaxonomies
NY283986207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine