Healthcare Provider Details

I. General information

NPI: 1457036659
Provider Name (Legal Business Name): SHADRACK KWAKU DUGBATEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRONX - LEBANON HOSPITAL CENTER, 1650 GRAND CONCOURSE
BRONX NY
10457
US

IV. Provider business mailing address

24 THE RISE
CONGERS NY
10920-2114
US

V. Phone/Fax

Practice location:
  • Phone: 917-340-9465
  • Fax:
Mailing address:
  • Phone: 917-340-9465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number345171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: