Healthcare Provider Details

I. General information

NPI: 1053236414
Provider Name (Legal Business Name): CELESTIN MISSIKPODE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SAINT EDWARDS ST
BROOKLYN NY
11201-3904
US

IV. Provider business mailing address

140 SAINT EDWARDS ST
BROOKLYN NY
11201-3904
US

V. Phone/Fax

Practice location:
  • Phone: 718-858-6400
  • Fax: 718-327-3294
Mailing address:
  • Phone: 718-858-6400
  • Fax: 718-327-3294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP143991
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: