Provider Demographics
NPI:1417198003
Name:ANUMBA, EMEKA C (MD)
Entity Type:Individual
Prefix:DR
First Name:EMEKA
Middle Name:C
Last Name:ANUMBA
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 1:1200 E GENESEE ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1936
Mailing Address - Country:US
Mailing Address - Phone:315-299-6116
Mailing Address - Fax:
Practice Address - Street 1:1200 E GENESEE ST
Practice Address - Street 2:SUITE 207
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1936
Practice Address - Country:US
Practice Address - Phone:315-299-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163558207VG0400X, 207V00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB82417Medicare UPIN