Healthcare Provider Details

I. General information

NPI: 1831542661
Provider Name (Legal Business Name): TOBECHI L. EBEDE, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2016
Last Update Date: 07/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 COURT ST SUITE 1005
BROOKLYN NY
11242-0103
US

IV. Provider business mailing address

26 COURT ST SUITE 1005
BROOKLYN NY
11242-0103
US

V. Phone/Fax

Practice location:
  • Phone: 718-522-6647
  • Fax: 718-858-2461
Mailing address:
  • Phone: 718-522-6647
  • Fax: 718-858-2461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number245700
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number245700
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number245700
License Number StateNY

VIII. Authorized Official

Name: TOBECHI EBEDE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 718-522-6647