National Provider Identifier
Ejiro Vivian Agboro-Idahosa, M.D
Ejiro Vivian Agboro-Idahosa, M.D is listed in the NPPES registry with a primary specialty of Child & Adolescent Psychiatry Physician in Elmira, NY and a listed phone number of (607) 737-7002.
Profile Overview
- NPI
- 1104089390
- Provider Type
- Individual
- Primary Specialty
- Child & Adolescent Psychiatry Physician
- Enumeration Date
- July 08, 2008
- Last Updated
- June 08, 2016
Practice Location
- 555 Saint Josephs Blvd
- Elmira, NY 14901-3223
Phone: (607) 737-7002
Mailing Address
- 571 Saint Josephs Blvd Fl 2
- Elmira, NY 14901-3230
Specialties
- Child & Adolescent Psychiatry Physician (2084P0804X)
- Psychiatry Physician (2084P0800X)
Full Record
- NPI
- 1104089390
- Entity Type
- Individual
- Last Name
- Agboro-Idahosa
- First Name
- Ejiro
- Middle Name
- Vivian
- Name Prefix
- Dr.
- Credential
- M.D
- Provider Other Last Name
- Agboro
- Provider Other First Name
- Ejiro
- Provider Other Middle Name
- Vivian
- Provider Other Name Prefix Text
- Dr.
- Provider Other Credential Text
- M.D
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 571 Saint Josephs Blvd Fl 2
- Mailing City
- Elmira
- Mailing State
- NY
- Mailing ZIP Code
- 14901-3230
- Mailing Country
- US
- Mailing Phone
- (607) 271-2050
- Practice Street Address
- 555 Saint Josephs Blvd
- Practice City
- Elmira
- Practice State
- NY
- Practice ZIP Code
- 14901-3223
- Practice Country
- US
- Practice Phone
- (607) 737-7002
- Practice Fax
- (607) 737-1529
- Enumeration Date
- July 08, 2008
- Last Updated
- June 08, 2016
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Child & Adolescent Psychiatry Physician (2084P0804X), Psychiatry Physician (2084P0800X)
- Other Identifiers
- 38473 (IA, Iowa License), 275859 (NY, State License), 1243767 (IA, Controlled Substance Certificate), 04061661 (NY)