MEDICARE: MS. IZEHI AGENMONMEN EROMOSELE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	405807	NY
2	363LF0000X	Family Nurse Practitioner	341154-01	NY
3	363LF0000X	Family Nurse Practitioner	341154	NY
4	163W00000X	Registered Nurse	580957	NY

General Provider Information

NPI Number	:	1003124660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IZEHI AGENMONMEN EROMOSELE NP

Provider Business Mailing Address
First Line	:	539 VANDALIA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11239-2853
Country	:	US
Telephone Number	:	646-287-0094
Fax Number	:	800-707-8708

Provider Business Practice Location Address
First Line	:	539 VANDALIA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11239-2810
Country	:	US
Telephone Number	:	718-642-3213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2010
Last Update Date	:	09/17/2025

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