Healthcare Provider Details

I. General information

NPI: 1215325238
Provider Name (Legal Business Name): EBENEZER ONI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2014
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S 5TH AVE
WEST READING PA
19611
US

IV. Provider business mailing address

121 DEKALB AVE # 19
BROOKLYN NY
11201-5425
US

V. Phone/Fax

Practice location:
  • Phone: 484-628-5455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number62924
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD461475
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: