Provider Demographics
NPI:1629376447
Name:IFEOMA EZEKWO,M.D.
Entity Type:Organization
Organization Name:IFEOMA EZEKWO,M.D.
Other - Org Name:BRONX EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IFEOMA
Authorized Official - Middle Name:ERNESTINA
Authorized Official - Last Name:EZEKWO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-367-7888
Mailing Address - Street 1:3013 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1428
Mailing Address - Country:US
Mailing Address - Phone:718-367-7888
Mailing Address - Fax:
Practice Address - Street 1:3013 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1428
Practice Address - Country:US
Practice Address - Phone:718-367-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156622332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0799959Medicaid
NY08D331Medicare PIN
NYA99121Medicare UPIN