1831542661 NPI number — TOBECHI L. EBEDE, MD, PLLC

Table of content: (NPI 1831542661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831542661 NPI number — TOBECHI L. EBEDE, MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOBECHI L. EBEDE, MD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PLAZA PARK DERMATOLOGY
Provider Other Organization Name Type Code:
3
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:
1831542661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 COURT ST
Provider Second Line Business Mailing Address:
SUITE 1005
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11242-0103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-522-6647
Provider Business Mailing Address Fax Number:
718-858-2461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 COURT ST
Provider Second Line Business Practice Location Address:
SUITE 1005
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11242-0103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-522-6647
Provider Business Practice Location Address Fax Number:
718-858-2461
Provider Enumeration Date:
07/17/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EBEDE
Authorized Official First Name:
TOBECHI
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
718-522-6647

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  245700 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ND0101X , with the licence number: 245700 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NS0135X , with the licence number: 245700 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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