Healthcare Provider Details

I. General information

NPI: 1134983935
Provider Name (Legal Business Name): TEDDY OSAZUWA UZAMERE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 1ST ST
MINEOLA NY
11501-3957
US

IV. Provider business mailing address

18641 ELMIRA AVE
SAINT ALBANS NY
11412-1517
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-0333
  • Fax:
Mailing address:
  • Phone: 347-475-5596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number031625
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: