Healthcare Provider Details

I. General information

NPI: 1588423768
Provider Name (Legal Business Name): VICTOR SOSU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E 77TH ST
NEW YORK NY
10075-1851
US

IV. Provider business mailing address

ROAD TOWN, PO BOX 741
TORTOLA BRITISH VIRGIN ISLAND
BV 1110
VG

V. Phone/Fax

Practice location:
  • Phone: 212-434-3266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number207RN0300X
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: