Ebenezer Odoom MD PC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

Legal business name

EBENEZER ODOOM MD PC

Practice address

21530 Hillside Ave
Queens Village, NY 11427-1831

Phone

(718) 740-1701

Fax

(718) 740-1901

NPI assigned

Jul 18, 2013

Organization subpart

No

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

Authorized official

Name

Ebenezer Odoom, MD

Title

President

Phone

(347) 276-4570

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1374105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374105600000",
    "number": "1942642038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21530 HILLSIDE AVE",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114271831",
            "telephone_number": "718-740-1701",
            "fax_number": "718-740-1901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21530 HILLSIDE AVE",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114271831",
            "telephone_number": "718-740-1701",
            "fax_number": "718-740-1901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER ODOOM MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-18",
        "last_updated": "2013-07-18",
        "status": "A",
        "authorized_official_last_name": "ODOOM",
        "authorized_official_first_name": "EBENEZER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "347-276-4570",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Internal Medicine) Physician in Queens Village, NY
• Providers in Queens Village, NY by specialty
• Geriatric Medicine (Internal Medicine) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.