Healthcare Provider Details

I. General information

NPI: 1417198003
Provider Name (Legal Business Name): EMEKA C ANUMBA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E GENESEE ST SUITE 207
SYRACUSE NY
13210-1936
US

IV. Provider business mailing address

1200 E GENESEE ST SUITE 207
SYRACUSE NY
13210-1936
US

V. Phone/Fax

Practice location:
  • Phone: 315-299-6116
  • Fax:
Mailing address:
  • Phone: 315-299-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number163558
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number163558
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number163558
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: