Provider Demographics
NPI:1598521601
Name:UMEBUANI, EDMUND (MD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:UMEBUANI
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 1:6918 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2033
Mailing Address - Country:US
Mailing Address - Phone:718-639-9100
Mailing Address - Fax:516-217-0772
Practice Address - Street 1:6918 32ND AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2033
Practice Address - Country:US
Practice Address - Phone:718-639-9100
Practice Address - Fax:516-217-0772
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP126842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine