DR. EJIRO VIVIAN AGBORO-IDAHOSA M.D
NPI 1104089390
Psychiatry & Neurology - Child & Adolescent Psychiatry in Elmira, NY

Q: What is the provider's specialty?

The provider's specialty is Psychiatry & Neurology with taxonomy code 2084P0804X and a focus in Child & Adolescent Psychiatry.

Active since July 08, 2008PECOS EnrolledAccepts Medicare Assignment

555 SAINT JOSEPHS BLVD, ELMIRA, NY 14901(607) 737-7002(607) 737-1529 Get Directions Write a Review

NPPES record last updated: June 8, 2016. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Dr. Ejiro Vivian Agboro-idahosa M.d NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. EJIRO VIVIAN AGBORO-IDAHOSA M.D (NPI 1104089390) is an individual child & adolescent psychiatry provider in Elmira, New York, licensed in Iowa (38473) and active in the NPI registry since July 2008. She is enrolled in Medicare PECOS and is a graduate of Other (1994).

NPPES Registry Identity

NPI1104089390

Entity TypeIndividualFemale

Primary Taxonomy2084P0804X

Provider Legal NameDR. EJIRO VIVIAN AGBORO-IDAHOSACredential: M.D

Location Address555 SAINT JOSEPHS BLVDElmira, NY 14901-3223

Mailing Address571 Saint Josephs Blvd Fl 2Elmira, NY 14901-3230 · (607) 271-2050

Phone(607) 737-7002

Fax(607) 737-1529

Sole ProprietorNo

Medical School CMSOtherGraduated 1994

Enumeration DateJuly 8, 2008

Last NPPES UpdateJune 8, 2016

✔ NPI 1104089390 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychiatry & Neurology · Child & Adolescent PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0804X

License✔ Licensed in IA · 38473

Definition

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.

Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X · License 38473 (IA), 275859 (NY)

555 SAINT JOSEPHS BLVD, Elmira, NY 14901

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Other Names 1

Former Name (1)Dr. Ejiro Vivian Agboro M.d

Other Identifiers 5

Other1243767IA · Controlled Substance Certificate

Other275859NY · State License

Medicare PINJ400234633NY

Other38473IA · Iowa License

Medicaid04061661NY

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Ejiro Vivian Agboro-idahosa M.d is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1355495649

PECOS Enrollment IDI20150617001896

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RANDY LEE HUNTINGTON JR. PA-C

Physician Assistant