Healthcare Provider Details

I. General information

NPI: 1245735372
Provider Name (Legal Business Name): LYDIA SOMUAH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E 241ST ST
BRONX NY
10470-1303
US

IV. Provider business mailing address

120 ELGAR PL APT 5K
BRONX NY
10475-5173
US

V. Phone/Fax

Practice location:
  • Phone: 718-671-2100
  • Fax:
Mailing address:
  • Phone: 917-518-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number747259
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number350339
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: