Healthcare Provider Details

I. General information

NPI: 1639335714
Provider Name (Legal Business Name): ALEXANDER AZUKA JUWAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WASHINGTON STREET ELMIRA PSYCHIATRIC CENTER
ELMIRA NY
14901
US

IV. Provider business mailing address

100 WASHINGTON STREET ELMIRA PSYCHIATRIC CENTER
ELMIRA NY
14901
US

V. Phone/Fax

Practice location:
  • Phone: 607-737-4841
  • Fax:
Mailing address:
  • Phone: 607-737-4841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberP63718
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: