Healthcare Provider Details

I. General information

NPI: 1811473721
Provider Name (Legal Business Name): OKYENIBA MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 EAST KINGSBRIDGE ROAD
BRONX NY
10468
US

IV. Provider business mailing address

58 E KINGSBRIDGE RD
BRONX NY
10468-7517
US

V. Phone/Fax

Practice location:
  • Phone: 718-295-8243
  • Fax:
Mailing address:
  • Phone: 718-295-8243
  • Fax: 718-584-3805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number144315
License Number StateNY

VIII. Authorized Official

Name: DR. SAMUEL K MENSAH
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 718-295-8243