Healthcare Provider Details

I. General information

NPI: 1497853451
Provider Name (Legal Business Name): MICHAEL O ABBEY-MENSAH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 MOTHER GASTON BLVD
BROOKLYN NY
11212-7617
US

IV. Provider business mailing address

322 NASSAU AVE
FREEPORT NY
11520-6119
US

V. Phone/Fax

Practice location:
  • Phone: 718-485-2704
  • Fax:
Mailing address:
  • Phone: 718-485-2704
  • Fax: 516-385-9279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number159078
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: