Active NPI
Abieyuwa Eboikpomwen
- Internal Medicine Physician
- Albert Lea, MN
National Provider Identifier
1043404635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 283986
- Practice address
- 404 W Fountain St
Albert Lea, MN 56007-2437 - Phone
- (786) 488-1749
- NPI assigned
- Aug 28, 2007
- Reactivated
- Aug 24, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 283986 | NY | Primary |
Addresses
Primary practice location
404 W Fountain St
Albert Lea, MN 56007-2437
Mailing address
300 Lenox Rd
Apt 7K
Brooklyn, NY 11226-2273
Phone (786) 488-1749
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 283986 | NY | MD | Internal Medicine Physician |
Interoperability endpoints
- aeboikpomwen675068@nychhc.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667779200000",
"number": "1043404635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 LENOX RD",
"address_2": "APT 7K",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112262273",
"telephone_number": "786-488-1749"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 W FOUNTAIN ST",
"city": "ALBERT LEA",
"state": "MN",
"postal_code": "560072437",
"telephone_number": "786-488-1749"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBOIKPOMWEN",
"first_name": "ABIEYUWA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-28",
"last_updated": "2022-11-07",
"certification_date": "2022-11-02",
"deactivation_date": "2009-08-31",
"reactivation_date": "2012-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NY",
"license": "283986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albert Lea, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.