Healthcare Provider Details

I. General information

NPI: 1538300934
Provider Name (Legal Business Name): GEVANS MEDICAL PRACTICE P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 GIVAN AVE
BRONX NY
10469-2924
US

IV. Provider business mailing address

1280 GIVAN AVE
BRONX NY
10469-2924
US

V. Phone/Fax

Practice location:
  • Phone: 347-449-5936
  • Fax: 347-449-5937
Mailing address:
  • Phone: 347-449-5936
  • Fax: 347-449-5937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number232053
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number232053
License Number StateNY

VIII. Authorized Official

Name: DR. GEORGE EVANS OWUSU
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 917-385-9399