Healthcare Provider Details

I. General information

NPI: 1558447839
Provider Name (Legal Business Name): PHILIP OWUSU-ANSAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4742 WHITE PLAINS RD STE. 1
BRONX NY
10470-1117
US

IV. Provider business mailing address

4742 WHITE PLAINS RD STE1
BRONX NY
10470-1117
US

V. Phone/Fax

Practice location:
  • Phone: 718-882-2835
  • Fax: 718-882-8176
Mailing address:
  • Phone: 718-882-2835
  • Fax: 718-882-8176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number209192
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: