Organization
EBENEZER ODOOM MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBENEZER ODOOM MD (PRESIDENT)
(347) 276-4570
Entity
Organization
Contact information
Practice address
21530 HILLSIDE AVE, QUEENS VILLAGE, NY 11427-1831
(718) 740-1701
(718) 740-1901
Mailing address
21530 HILLSIDE AVE, QUEENS VILLAGE, NY 11427-1831
(718) 740-1701
(718) 740-1901
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
07/18/2013
Last updated
07/18/2013
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