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

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: November 01, 2026.

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

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

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.

Medicare Billing Reassignment

Medicare enrollment records show Ejiro Agboro-idahosa reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Waverly Medical Associates LLC
15 mi
Internal Medicine
348 BROAD ST
Waverly, NY 14892
  • Reassigned Medicare billing, New York enrollment
  • 2 clinicians in this Medicare group
NPI 1457757486 (607) 821-2444

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

SARAH ELIZABETH WATSON MS, OTR/L, ATC/L
Occupational Therapist
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901
Chemung County (570) 447-8799
JOSHUA SCOTT TRYON OTR/L
Occupational Therapist
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901
Chemung County (607) 737-7804
JACLYN PERKINS MS, OTR/L
Occupational Therapist
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901
Chemung County (607) 733-6541
DEBORAH ANN DELARY PTA
Physical Therapy Assistant
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901
Chemung County (607) 733-6541
MRS. KAREN ELIZABETH COULTER OTR
Occupational Therapist (Physical Rehabilitation)
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901
Chemung County (607) 733-6541
BELINDA ANN HOLLENBECK
Nurse Practitioner (Psychiatric/Mental Health)
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901
Chemung County (607) 737-7002
DEBRA LUCILLE WILLSEY FNP PSYCH
Nurse Practitioner (Psychiatric/Mental Health)
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901
Chemung County (607) 737-7002
ARNOT OGDEN MEDICAL CENTER
General Acute Care Hospital
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901
Chemung County (607) 733-6541

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ejiro Agboro-idahosa's NPI number?

The NPI number for Ejiro Agboro-idahosa is 1104089390. It was assigned to this individual provider in the NPPES registry on July 8, 2008. The provider is also known as Dr. Ejiro Vivian Agboro M.D.

Where is Ejiro Agboro-idahosa located?

Ejiro Agboro-idahosa practices at 555 Saint Josephs Blvd, Elmira, NY 14901. The listed phone number is (607) 737-7002.

What is Ejiro Agboro-idahosa's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Child & Adolescent Psychiatry, with taxonomy code 2084P0804X.

Is Ejiro Agboro-idahosa enrolled in Medicare?

Yes. Ejiro Agboro-idahosa is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Ejiro Agboro-idahosa's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Ejiro Agboro-idahosa reassigns Medicare benefits to Waverly Medical Associates LLC (Waverly, NY). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Ejiro Agboro-idahosa's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Ejiro Agboro-idahosa was last updated on June 8, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.