Individual provider Active NPI

Otibhor K Agbi, PA

  • Physician Assistant
  • Bronx, NY
National Provider Identifier
1437231602
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
009870 Issued in NY
Practice address
MMC - Vascular Surgery
1825 Eastchester Road
Bronx, NY 10461
Phone
(917) 949-0061
NPI assigned
Oct 19, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 009870 NY Primary

Addresses

Primary practice location

MMC - Vascular Surgery
1825 Eastchester Road
Bronx, NY 10461

Mailing address

11536 Mexico St
Saint Albans, NY 11412-2647
Phone (917) 949-0061

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20071025000525 NY Practitioner - Physician Assistant 6002903812 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
009870NYMDOptician

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Jun 25, 2017 Accepting new patients
Montefiore Medical Center CurrentSince Jun 25, 2017 Accepting new patients
Jamaica Hospital CurrentSince Nov 1, 2021 Accepting new patients
Jamaica Hospital CurrentSince Nov 1, 2021 Accepting new patients
Montefiore Mount Vernon Hospital Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

1825 Eastchester Rd
Bronx, NY 10461
Phone (718) 904-2000

80 Marcus Dr
Melville, NY 11747
Phone (631) 391-7889

111 E 210th St
New York, NY 10087

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437231602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11536 MEXICO ST",
            "city": "SAINT ALBANS",
            "state": "NY",
            "postal_code": "114122647",
            "telephone_number": "917-949-0061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MMC - VASCULAR SURGERY",
            "address_2": "1825 EASTCHESTER ROAD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10461",
            "telephone_number": "917-949-0061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGBI",
        "first_name": "OTIBHOR",
        "middle_name": "K",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "009870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.