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NPI Code Detail

MEDICARE: MITAIRE OKEOGHENE ERHIEYOVWE MD

MEDICARE: MITAIRE OKEOGHENE ERHIEYOVWE MD
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1558201954
Entity Type Code : Individual
Provider Name (Legal Business Name) : MITAIRE OKEOGHENE ERHIEYOVWE MD
Provider Business Mailing Address
First Line : 314 LINCOLN ST
Second Line :
City : LINDEN
State : NJ
Zip : 07036-2315
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 475 SEAVIEW AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3436
Country : US
Telephone Number : 718-226-8630
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2026
Last Update Date : 03/30/2026

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