MEDICARE: DR. GEOFFREY ACHONU M.D.

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	208000000X	Pediatrics Physician	238548	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083710396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEOFFREY ACHONU M.D.

Provider Business Mailing Address
First Line	:	787 ADAMS ST
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-4302
Country	:	US
Telephone Number	:	516-623-1629
Fax Number	:

Provider Business Practice Location Address
First Line	:	1162 EASTERN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-4108
Country	:	US
Telephone Number	:	718-221-0333
Fax Number	:	718-221-1087

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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