Provider Demographics
NPI:1184834459
Name:EZEKWO, IFEOMA ERNESTINA (MD)
Entity Type:Individual
Prefix:DR
First Name:IFEOMA
Middle Name:ERNESTINA
Last Name:EZEKWO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1428
Mailing Address - Country:US
Mailing Address - Phone:718-367-7888
Mailing Address - Fax:718-733-5744
Practice Address - Street 1:3013 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1428
Practice Address - Country:US
Practice Address - Phone:718-367-7888
Practice Address - Fax:718-733-5744
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156622207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00799959Medicaid
NY08D331Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NYA99121Medicare UPIN