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General NPI Number Information
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NPI Number | 1376433474
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Entity Type | Individual
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Provider Name | DR. EVELYN EHIAGHE IZIBILI
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Gender | Female
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 140 SAINT EDWARDS ST
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City | BROOKLYN
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State | NY
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Zip | 11201-3904
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Country | US
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Telephone | 516-641-4585
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Fax |
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Provider Business Mailing Address
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Address Line | 623 ANGLEWOOD DR
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City | RICHARDSON
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State | TX
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Zip | 75081-4806
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Country | US
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Telephone | 214-254-0894
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Fax | 214-254-0894
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | P136221
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License Number State | NY
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