| Ebenezer Odoom Md Pc | |
|
21530 Hillside Ave Queens Village NY 11427-1831 | |
| (718) 740-1701 | |
| (718) 740-1901 |
| Full Name | Ebenezer Odoom Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 21530 Hillside Ave, Queens Village, New York |
| Authorized Official Name and Position | Ebenezer Odoom (PRESIDENT) |
| Authorized Official Contact | 3472764570 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ebenezer Odoom Md Pc 21530 Hillside Ave Queens Village NY 11427-1831 Ph: (718) 740-1701 | Ebenezer Odoom Md Pc 21530 Hillside Ave Queens Village NY 11427-1831 Ph: (718) 740-1701 |
| NPI Number | 1942642038 |
|---|---|
| Provider Enumeration Date | 07/18/2013 |
| Last Update Date | 07/18/2013 |
| Medicare PECOS PAC ID | 5597991935 |
|---|---|
| Medicare Enrollment ID | O20131113001552 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942642038 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (* (Not Available)) | Secondary |
| Provider Name | Ebenezer Kb Odoom |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154416691 PECOS PAC ID: 9032190947 Enrollment ID: I20040526001449 |
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