Provider Demographics
NPI:1023596699
Name:EDOBOR, HENRY O
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:O
Last Name:EDOBOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14927 JAMAICA AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-4078
Mailing Address - Country:US
Mailing Address - Phone:718-880-1974
Mailing Address - Fax:718-880-1974
Practice Address - Street 1:14927 JAMAICA AVE STE 5
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-4078
Practice Address - Country:US
Practice Address - Phone:718-880-1974
Practice Address - Fax:718-880-1974
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-05
Last Update Date:2018-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child