Provider Demographics
NPI:1578824918
Name:IRUMUDOMON, OBEHIOYA T (MD)
Entity Type:Individual
Prefix:
First Name:OBEHIOYA
Middle Name:T
Last Name:IRUMUDOMON
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2001 MARCUS AVE STE W290
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1098
Mailing Address - Country:US
Mailing Address - Phone:516-465-5255
Mailing Address - Fax:
Practice Address - Street 1:2001 MARCUS AVE STE W290
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-465-5255
Practice Address - Fax:718-347-2240
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2019-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2808012084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty