DR. EJIRO VIVIAN AGBORO-IDAHOSA (NPI# 1104089390) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104089390 |
| Entity Type | Individual |
| Full Name | DR. EJIRO VIVIAN AGBORO-IDAHOSA |
| Other Name | DR. EJIRO VIVIAN AGBORO |
| Credential | M.D |
| Practice Address |
555 Saint Josephs Blvd Elmira NY 14901-3223 |
| Mailing Address |
571 Saint Josephs Blvd Fl 2 Elmira NY 14901-3230 |
| Practice Telephone | 6077377002 |
| Practice Fax Number | 6077371529 |
| Mailing Telephone | 6072712050 |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2016-06-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
275859 | NY | Allopathic & Osteopathic Physicians |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
38473 | IA | Allopathic & Osteopathic Physicians |
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
38473 | IA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | CONTROLLED SUBSTANCE CERTIFICATE | 1243767 | 01 |
| NY | 04061661 | 05 | |
| IA | IOWA LICENSE | 38473 | 01 |
| NY | STATE LICENSE | 275859 | 01 |
| Street Address |
555 SAINT JOSEPHS BLVD |
| City | ELMIRA |
| State | NY |
| Zip Code | 14901-3223 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740256809 | Sydney Welt | Internal Medicine | 555 Saint Josephs Blvd, Elmira, NY 14901-3223 | 2006-02-27 |
| 1467092452 | Madison Kathryn Gluck | Physical Therapist | 555 Saint Josephs Blvd, Elmira, NY 14901-3256 | 2020-01-08 |
| 1992345003 | Rachel Bush | Physical Therapist | 555 Saint Josephs Blvd, Elmira, NY 14901-3223 | 2020-01-07 |
| 1831742816 | Nes Medical Services of New York PC | Emergency Medicine | 555 Saint Josephs Blvd, Elmira, NY 14901-3223 | 2019-07-19 |
| 1841759529 | Amanda M Northrop | Occupational Therapist | 555 Saint Josephs Blvd, Elmira, NY 14901-3223 | 2019-03-13 |
| 1245708056 | Emily Pauline Clark | Physical Medicine & Rehabilitation | 555 Saint Josephs Blvd, Elmira, NY 14901-3223 | 2018-11-09 |
| 1821563347 | Tarah Marie Babcock | Physical Therapist | 555 Saint Josephs Blvd, Elmira, NY 14901-3223 | 2018-10-11 |
| 1992289888 | Sarah Jessica Osburn | Physical Therapy Assistant | 555 Saint Josephs Blvd, Elmira, NY 14901-3223 | 2018-09-18 |
| 1770069536 | St. Joseph's Hospital | Clinic/Center | 555 Saint Josephs Blvd, Elmira, NY 14901-3223 | 2018-07-16 |
| 1942707583 | Andrey Takhtovich | Student in an Organized Health Care Education/Training Program | 555 Saint Josephs Blvd, Elmira, NY 14901-3223 | 2018-04-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447818182 | Davida Reane Moss | Case Manager/Care Coordinator | 310 Pensyvania Avenue, Elmira, NY 14901 | 2019-05-29 |
| 1316504889 | Jessica Leigh Badilla | Counselor | 1013 Water St, Elmira, NY 14901 | 2019-05-21 |
| 1427508811 | Cynthia Ann Sullivan | Counselor | 1019 E. Water Street, Elmira, NY 14901 | 2016-10-10 |
| 1508313362 | Kim Burlew | Case Manager/Care Coordinator | 1019 W. Water Street Family Services of Chemung County, Elmire, NY 14901 | 2016-09-08 |
| 1396195095 | State of New York Comptrollers Office | Clinic/Center | 164 Sullivan Street, Elmira, NY 14901 | 2016-06-14 |
| 1285089581 | Tasha R Miller | Licensed Practical Nurse | 426 Woodawn Ct, Elmira, NY 14901 | 2016-04-25 |
| 1750628111 | Kelly E Bartle-bush | Social Worker | 711 Sullivan St., Elmira, NY 14901 | 2013-01-04 |
| 1144594946 | Brian Mustico | Occupational Therapist | 512 West Clinton Street, Apartment B, Elmira, NY 14901 | 2012-02-27 |
| 1063780880 | Deidre Ann Callaghan | Physical Therapy Assistant | 555 St.josephs Blvd, Elmira, NY 14901 | 2011-12-07 |
| 1972889467 | Arnot Health | General Acute Care Hospital | 1 St.joseph's Blvd., Elmira, NY 14901 | 2011-10-27 |
| Find all providers in zip 14901 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639335714 | Alexander Azuka Juwah | Psychiatry & Neurology | 100 Washington Street, Elmira Psychiatric Center, Elmira, NY 14901 | 2008-07-29 |
| 1427184829 | Syed H Jaffery | Psychiatry & Neurology | 1019 E Water St, Elmira, NY 14901-3332 | 2007-02-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093327611 | Adel Mostafavi, Md PC | Psychiatry & Neurology | 104 W 40th St Rm 400, New York, NY 10018-3692 | 2020-08-17 |
| 1023632015 | Child and Adult Clinical Psychiatry PC | Psychiatry & Neurology | 75 Prospect St Ste 110, Huntington, NY 11743-3320 | 2020-06-04 |
| 1598306441 | Place of Mind Child, Adolescent, and Adult Psychiatry P.C. | Psychiatry & Neurology | 240 Central Park S Apt 2h, New York, NY 10019-1435 | 2019-10-02 |
| 1881102267 | Park Avenue Physicians PC | Psychiatry & Neurology | 5 W 86th St Apt 1b, New York, NY 10024-3663 | 2018-01-19 |
| 1518478080 | Diego G. Calabria Physician P.C. | Psychiatry & Neurology | 366 N Broadway Ste 304, Jericho, NY 11753-2000 | 2017-10-23 |
| 1013426865 | Bebsy Estefan Md PC | Psychiatry & Neurology | 3050 Corlear Ave # Phb, Bronx, NY 10463-5180 | 2017-09-25 |
| 1902281629 | Derek Rudge | Psychiatry & Neurology | 1051 Riverside Dr Rm 235, New York, NY 10032-1007 | 2015-07-23 |
| 1275918096 | Dr Omar Bashayan Physician Pllc | Psychiatry & Neurology | 155 W 68th St Apt 1102, New York, NY 10023-5816 | 2015-07-22 |
| 1740676766 | Maura E Tappen | Psychiatry & Neurology | 1860 South Ave, Rochester, NY 14620-4229 | 2015-04-07 |
| 1194119560 | Krishen Persaud | Psychiatry & Neurology | Stony Brook Psychiatric Associates, Ufpc, Sbumc, Hsc Level 10, Rm.020, Stony Brook, NY 11794-8101 | 2015-03-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.