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: July 19, 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
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

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

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.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the 2024 & 2026 CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit, 30-39 minutes 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
79 services11 patients
Psychotherapy with evaluation and management visit, 45 minutes 90836
Psychotherapy with evaluation and management is a 45-minute session where a healthcare provider discusses your mental and emotional health. They assess your current state, manage any issues, and help you develop coping strategies. This service aims to improve your overall well-being.
67 services11 patients

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.

Internal Medicine (Medical Oncology)
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901
Physician Assistant
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901
Physical Therapist
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901
General Acute Care Hospital
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901
Physical Therapy Assistant
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901
Physical Therapy Assistant
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901
Occupational Therapist (Physical Rehabilitation)
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901
Physical Therapist
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1104089390, enumerated as an "individual" on July 08, 2008.

The provider is located at 555 SAINT JOSEPHS BLVD ELMIRA, NY 14901 and the phone number is (607) 737-7002.

Psychiatry & Neurology with taxonomy code 2084P0804X and a focus in Child & Adolescent Psychiatry.

The provider might be accepting Accepts: Providence Health Plan, Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.