EBENEZER ODOOM MD PC NPI 1942642038

NPI Information

  • NPI: 1942642038
  • Provider Name: EBENEZER ODOOM MD PC
  • Classification: Internal Medicine - 207RG0300X
  • Specialization: Geriatric Medicine
  • Entity Type: Organization
  • CLIA Number: 33D2068083
  • Address: 21530 HILLSIDE AVE
    QUEENS VILLAGE, NY
    ZIP 11427
  • Phone: (718) 740-1701

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NPI Details

EBENEZER ODOOM MD PC is a geriatric medicine internal medicine in Queens Village, NY. The provider is an internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. EBENEZER ODOOM MD PC NPI is 1942642038. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

21530 HILLSIDE AVE
QUEENS VILLAGE, NY
ZIP 11427-831
Phone: (718) 740-1701
Fax: (718) 740-1901

The provider's authorized official is Ebenezer Odoom .
The authorized official title is President and has the following contact phone number (347) 276-4570.

The CLIA number assigned to this NPI record is 33D2068083 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/18/2013 and was last updated on 7/18/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsNo
2207RG0300XInternal MedicineGeriatric MedicineYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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