Healthcare Provider Details

I. General information

NPI: 1801934625
Provider Name (Legal Business Name): DR. MORRIS EFOBI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 VAN WYCK EXPY
JAMAICA NY
11418-2897
US

IV. Provider business mailing address

8900 VAN WYCK EXPY
JAMAICA NY
11418-2897
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-6290
  • Fax:
Mailing address:
  • Phone: 718-206-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number153088
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: