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General NPI Number Information
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NPI Number | 1922306216
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Entity Type | Organization
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Legal Business Name | IFEOMA EZEKWO, M.D.
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 69 MAIN ST
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City | PATERSON
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State | NJ
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Zip | 07505-1027
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Country | US
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Telephone | 862-239-5253
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Fax |
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Provider Business Mailing Address
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Address Line | 69 MAIN ST
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City | PATERSON
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State | NJ
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Zip | 07505-1027
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Country | US
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Telephone | 862-239-5253
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. IFEOMA ERNESTINA EZEKWO
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Credential | M.D.
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Telephone | 862-239-5253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 156622
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 156622
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License Number State | NY
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