Provider Demographics
NPI:1629136619
Name:EMEGHEBO, IGNATIUS E (MD)
Entity Type:Individual
Prefix:DR
First Name:IGNATIUS
Middle Name:E
Last Name:EMEGHEBO
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 1:5606 SNYDER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-4711
Mailing Address - Country:US
Mailing Address - Phone:718-342-4600
Mailing Address - Fax:718-342-4601
Practice Address - Street 1:5606 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-4711
Practice Address - Country:US
Practice Address - Phone:718-342-4600
Practice Address - Fax:718-342-4601
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134083261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA97119Medicare UPIN