Agboro-Idahosa, Ejiro Vivian

Agboro-Idahosa, Ejiro Vivian is an individual health care provider with primary practice located at 555 Saint Josephs Blvd , Elmira NY 14901-3223. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry. Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry is her primary health care specialty. Agboro-Idahosa, Ejiro Vivian can be contacted via phone (607) 737-7002.

Contact Information

Primary practice address
555 Saint Josephs Blvd Elmira NY 14901-3223
Phone: (607) 737-7002
Fax: (607) 737-1529
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 38473 Iowa
Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry 2084P0804X 38473 Iowa
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 275859 New York

Profile Details

NPI number 1104089390
LBN Legal business name Agboro-Idahosa, Ejiro Vivian
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 8th, 2008
Last updated Jun 8th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104089390 NPPES
Iowa Other 38473 IOWA LICENSE
Iowa Other 275859 IOWA LICENSE
Iowa Other 1243767 IOWA LICENSE
Iowa MEDICAID 04061661 IOWA LICENSE

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