Healthcare Provider Details

I. General information

NPI: 1851567630
Provider Name (Legal Business Name): OBINNA EFOBI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVENUE BOX 6
BROOKLYN NY
11203-2056
US

IV. Provider business mailing address

389 WASHINGTON ST APT 24H
JERSEY CITY NJ
07302-8964
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-3977
  • Fax:
Mailing address:
  • Phone: 347-865-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA09415300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: