Healthcare Provider Details

I. General information

NPI: 1215091376
Provider Name (Legal Business Name): KWABENA BARIMAH OWUSU-DAPAAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 EASTON AVE STE 1A
SOMERSET NJ
08873-1855
US

IV. Provider business mailing address

710 EASTON AVE STE 1A
SOMERSET NJ
08873-1855
US

V. Phone/Fax

Practice location:
  • Phone: 732-246-1960
  • Fax: 732-246-3141
Mailing address:
  • Phone: 732-246-1960
  • Fax: 732-246-3141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA60340
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA06034000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: