1265506307 NPI number — DR. ESOCHI IHEOMA DDS

Table of content: (NPI 1427716737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265506307 NPI number — DR. ESOCHI IHEOMA DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IHEOMA
Provider First Name:
ESOCHI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265506307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 COMMERCE DR
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
FT WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19034-2714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-460-4254
Provider Business Mailing Address Fax Number:
215-646-6166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 W OLNEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19120-2220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-549-6868
Provider Business Practice Location Address Fax Number:
215-799-0251
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS036147 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101081660 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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