EBENEZER KOFI BENTUM ODOOM (NPI# 1154416691) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154416691 |
| Entity Type | Individual |
| Full Name | EBENEZER KOFI BENTUM ODOOM |
| Credential | MD |
| Practice Address |
182-19 Horace Harding Expressway Fresh Meadows NY 11365 |
| Mailing Address |
Po Box 27842 New York NY 10087 |
| Practice Telephone | 7186702903 |
| Practice Fax Number | 5164374167 |
| Mailing Telephone | 7186701651 |
| Mailing Fax Number | 5164374167 |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2008-04-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
230787-1 | NY | Allopathic & Osteopathic Physicians |
| Street Address |
182-19 HORACE HARDING EXPRESSWAY |
| City | FRESH MEADOWS |
| State | NY |
| Zip Code | 11365 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548355175 | Bradley Jay Marsh | Podiatrist | 182-19 Horace Harding Expressway, Fresh Meadows, NY 11365 | 2006-10-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427660653 | Melanie Batista | Massage Therapist | 71-55 Parsons Blvd, Fresh Meadows, NY 11365 | 2020-08-19 |
| 1497396378 | Celestina Andino | Registered Nurse | 194-15b 64th Circle, 3c, Fresh Meadows, NY 11365 | 2019-10-02 |
| 1659939304 | Bracha Kosoff | Occupational Therapist | 71-64 168th St., Flushing, NY 11365 | 2019-05-29 |
| 1295290419 | Kate Okeke | Licensed Practical Nurse | 188 04 64th Avenue, Fresh Meadow, NY 11365 | 2019-02-01 |
| 1669951497 | Jihee Woo | Registered Nurse | 189-04 6f Fresh Meadows, Queeens, NY 11365 | 2018-08-13 |
| 1710465125 | In Hye Choi | Acupuncturist | 67-02a 188st., Apt 3b, Fresh Meadows, NY 11365 | 2018-07-30 |
| 1497231112 | Shamain C Persaud | Case Manager/Care Coordinator | 67-28 188th Street, Fresh Meadows, NY 11365 | 2018-07-16 |
| 1598280489 | Gabriella Pamela Koyenova | Physician Assistant | 69-24 181st Street, Fresh Meadows, NY 11365 | 2017-08-11 |
| 1750802781 | Nicola Coley | Behavioral Analyst | 6747 161st Street, 1k, Flushing, NY 11365 | 2017-06-29 |
| 1811427941 | Jong M Lee | Acupuncturist | 6020b 194th St Apt 3b, Fresh Meadows, NY 11365 | 2017-06-12 |
| Find all providers in zip 11365 | ||||
| Taxonomy Code | 207RG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Geriatric Medicine |
| An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871855270 | Pavel Groysman | Internal Medicine | 17660 Union Tpke Ste 360, Fresh Meadows, NY 11366-1531 | 2012-06-12 |
| 1144296120 | Cynthia Pan | Internal Medicine | 5907 175th Pl, 2nd Floor, Fresh Meadows, NY 11365-1551 | 2006-02-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013518638 | Well Med Medical PC | Internal Medicine | 140a Washington Ave, Cedarhurst, NY 11516 | 2020-11-02 |
| 1770116956 | Wellbeing Medical Care, Pllc | Internal Medicine | 3745 75th Street, Jackson Heights, NY 11372-6435 | 2020-02-17 |
| 1962044396 | Shafi S Rana | Internal Medicine | 504 Hillside Blvd, New Hyde Park, NY 11040-2912 | 2019-10-17 |
| 1104468099 | Lebarty Medical Pllc | Internal Medicine | 317 Danielle Dr, Schenectady, NY 12303-5179 | 2019-10-11 |
| 1316591209 | Siddiqi Medical P.C. | Internal Medicine | Archcare At Mary Manning Walsh Home, 1339 York Avenue, New York, NY 10021 | 2019-07-29 |
| 1871153767 | Judith Alyce Salerno | Internal Medicine | 300 E 64th St Apt 27a, New York, NY 10065-7548 | 2019-06-13 |
| 1396259826 | Irina Powers Medical Pllc | Internal Medicine | 1562 1st Ave # 308, New York, NY 10028-4004 | 2017-11-20 |
| 1487027496 | Shujing Lin | Internal Medicine | 6309 New Utrecht Ave, Brooklyn, NY 11219-5425 | 2015-11-12 |
| 1073980744 | Young Soo Lee | Internal Medicine | 211 E 13th St, 4e, New York, NY 10003-5691 | 2015-08-28 |
| 1184007270 | Fiorella Myrella Perez | Internal Medicine | 1 Gustave L Levy Pl # 1070, New York, NY 10029 | 2015-07-07 |
| Find all providers with the same taxonomy | ||||
| City | FRESH MEADOWS |
| Zip Code | 11365 |
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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.