Provider Demographics
NPI:1457462871
Name:OFODILE, FERDINAND A (MD)
Entity Type:Individual
Prefix:
First Name:FERDINAND
Middle Name:A
Last Name:OFODILE
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 1:4048 JUNCTION BLVD # 1FL
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2122
Mailing Address - Country:US
Mailing Address - Phone:718-651-2843
Mailing Address - Fax:718-651-2846
Practice Address - Street 1:4048 JUNCTION BLVD # 1FL
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2122
Practice Address - Country:US
Practice Address - Phone:718-651-2843
Practice Address - Fax:718-651-2846
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109189-1208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0700512OtherGHI
NY109189OtherHIP
NYP402322OtherOXFORD
NY7918448OtherAETNA
NYB00214Medicaid
NYB00214Medicaid