Healthcare Provider Details

I. General information

NPI: 1487567186
Provider Name (Legal Business Name): LAWRENCE OPPONG-KYEKYEKU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MAYOR GIBSON BLVD APT 307
NEWARK NJ
07104-3987
US

IV. Provider business mailing address

110 MAYOR GIBSON BLVD APT 307
NEWARK NJ
07104-3987
US

V. Phone/Fax

Practice location:
  • Phone: 910-745-2412
  • Fax:
Mailing address:
  • Phone: 910-745-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF360432
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: