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General NPI Number Information
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NPI Number | 1942642038
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Entity Type | Organization
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Legal Business Name | EBENEZER ODOOM MD PC
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Dates
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Enumeration Date | 07/18/2013
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Last Update Date | 07/18/2013
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Provider Practice Location Address
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Address Line | 21530 HILLSIDE AVE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-1831
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Country | US
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Telephone | 718-740-1701
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Fax | 718-740-1901
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Provider Business Mailing Address
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Address Line | 21530 HILLSIDE AVE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-1831
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Country | US
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Telephone | 718-740-1701
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Fax | 718-740-1901
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Authorized Official
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Title or Position | PRESIDENT
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Name | EBENEZER ODOOM
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Credential | MD
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Telephone | 347-276-4570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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