Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Kenneth E Ezimoha, MD

Individual provider Internal Medicine Physician · NPI 1760377071

Dr. Kenneth E Ezimoha, MD is an Internal Medicine in Whitestone, New York. Qualified in 2004, 22 years ago. Practices with Mill Basin Medical Health PC, a 101-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
22
Licensed in
NY
In the registry since
2025
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

15715 19th Ave
Whitestone, NY 11357-3820
Phone: (718) 746-0408
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence P135556 (NY)

Record details

NPI number1760377071
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedJune 9, 2025
Last updated in NPPESJune 23, 2025
Certification dateJune 23, 2025
Mailing address15715 19th Ave, Whitestone, NY 11357-3820

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Mill Basin Medical Health Pc — 101 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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