Provider Demographics
NPI:1114286119
Name:IROHAM, WILSON NZEADIBE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILSON
Middle Name:NZEADIBE
Last Name:IROHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EDGEWOLD RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1008
Mailing Address - Country:US
Mailing Address - Phone:914-831-8519
Mailing Address - Fax:
Practice Address - Street 1:20 EDGEWOLD RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1008
Practice Address - Country:US
Practice Address - Phone:914-831-8519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264548-12084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty