Healthcare Provider Details

I. General information

NPI: 1366469918
Provider Name (Legal Business Name): OFEM AJAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/14/2023
Certification Date: 05/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 6TH AVE FL 4
BROOKLYN NY
11217-4350
US

IV. Provider business mailing address

94 LAKE DR
NEW HYDE PARK NY
11040-1137
US

V. Phone/Fax

Practice location:
  • Phone: 718-362-3260
  • Fax: 718-230-4235
Mailing address:
  • Phone: 516-375-3716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number192864
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number192864
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number192864
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: