Healthcare Provider Details

I. General information

NPI: 1538239918
Provider Name (Legal Business Name): OBOSA MEDICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MEMORIAL HWY SUITE 3-1
NEW ROCHELLE NY
10801-5635
US

IV. Provider business mailing address

175 MEMORIAL HWY SUITE 3-1
NEW ROCHELLE NY
10801-5635
US

V. Phone/Fax

Practice location:
  • Phone: 914-235-2387
  • Fax:
Mailing address:
  • Phone: 914-235-2387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANCIS AGBONKPOLO
Title or Position: OWNER
Credential: M.D.
Phone: 914-235-2387