Provider Demographics
NPI:1275023566
Name:IBEZIM, PATIENCE OGECHI (PA-C)
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:OGECHI
Last Name:IBEZIM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-2037
Mailing Address - Country:US
Mailing Address - Phone:585-355-0572
Mailing Address - Fax:
Practice Address - Street 1:2257 ADAM CLAYTON POWELL JR BLVD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-7979
Practice Address - Country:US
Practice Address - Phone:212-281-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant