Healthcare Provider Details

I. General information

NPI: 1407725310
Provider Name (Legal Business Name): EMMANUEL OWUSU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 E 164TH ST
BRONX NY
10456-6259
US

IV. Provider business mailing address

224 E 164TH ST
BRONX NY
10456-6259
US

V. Phone/Fax

Practice location:
  • Phone: 917-463-6797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN11248-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: