Healthcare Provider Details

I. General information

NPI: 1083032270
Provider Name (Legal Business Name): KWABENA YEBOA-ASUAMAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 ROSSER AVE
ELMONT NY
11003-3244
US

IV. Provider business mailing address

310 FULTON AVE
HEMPSTEAD NY
11550-3906
US

V. Phone/Fax

Practice location:
  • Phone: 516-672-4822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number717690549
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: