Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 277987 | NY |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 277987 | NY |
NPI | 1780655175 |
---|---|
Provider Name | Ebenezer O Babalola |
First Address | East Setauket, NY 11733-4079 |
Second Address | Arlington, TX 76017-5871 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 18/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080950100 | (05) | MN |
200613020A | (05) | KS |
H02166 | (02) |