Individual provider Active NPI

Izehi Agenmonmen Eromosele, NP

  • Family Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1003124660
Registry record updated Sep 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
341154 Issued in NY
Practice address
539 Vandalia Ave
Brooklyn, NY 11239-2810
Phone
(718) 642-3213
NPI assigned
Sep 16, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 405807 NY
Family Nurse Practitioner 363LF0000X 341154-01 NY
Family Nurse Practitioner 363LF0000X 341154 NY Primary
Registered Nurse 163W00000X 580957 NY

Addresses

Primary practice location

539 Vandalia Ave
Brooklyn, NY 11239-2810

Mailing address

539 Vandalia Ave
Brooklyn, NY 11239-2853
Phone (646) 287-0094

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, OR, AZ, NM4 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20200221000138 NY Practitioner - Nurse Practitioner 8921435579 Reassigns benefits to 3 organizations
I20250409003494 OR Practitioner - Nurse Practitioner 8921435579 Reassigns benefits to 1 organization
I20250422001292 AZ Practitioner - Nurse Practitioner 8921435579 Reassigns benefits to 1 organization
I20251030004289 NM Practitioner - Nurse Practitioner 8921435579 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

66 E Flagler St
Miami, FL 33130-1807

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
580957NYMDRegistered Nurse
341154-01NYMDFamily Nurse Practitioner
405807NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Psychiatric/Mental Health CurrentSince Mar 11, 2025 Accepting new patients
Brookview Medical Associates, PLLC CurrentSince Jan 1, 2025 Accepting new patients
Perfect Mind Care Psychiatry and Family Health PLLC Psychiatric/Mental Health CurrentSince Sep 1, 2024 Accepting new patients
New York City Health and Hospitals Corporation CurrentSince Mar 1, 2020 Accepting new patients
New York City Health and Hospitals Corporation Current Accepting new patients
New York City Health and Hospitals Corporation CurrentSince Mar 1, 2020 Accepting new patients
Orenda Psychiatry PLLC Psychiatric/Mental Health Past Accepting new patients

Locations

4600 E Washington St
Ste 300
Phoenix, AZ 85034
Phone (602) 638-1872

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

500 Marquette Ave NW
Ste 1200
Albuquerque, NM 87102
Phone (505) 295-6685

80 Orville Dr
Ste 100
Bohemia, NY 11716
Phone (516) 308-6610

594 Albany Ave
Brooklyn, NY 11203
Phone (646) 694-6680

165 Broadway
Fl 23
New York, NY 10006
Phone (202) 972-4964

50 Water St
Fl 3
New York, NY 10004

10260 SW Greenburg Rd
Fl 4
Tigard, OR 97223
Phone (503) 405-9338

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

522 W Riverside Ave
#8445
Spokane, WA 99201
Phone (718) 642-3213

Interoperability endpoints

  • Direct secure messaging: izehi.eromosele.1@24989.direct.athenahealth.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758067200000",
    "number": "1003124660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "539 VANDALIA AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112392853",
            "telephone_number": "646-287-0094",
            "fax_number": "800-707-8708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "539 VANDALIA AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112392810",
            "telephone_number": "718-642-3213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EROMOSELE",
        "first_name": "IZEHI",
        "middle_name": "AGENMONMEN",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-16",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "405807",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "341154-01",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "341154",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "580957",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.