Healthcare Provider Details

I. General information

NPI: 1053848226
Provider Name (Legal Business Name): PRISCILLA FORDJOUR AGYEMANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 WHITE PLAINS RD
TARRYTOWN NY
10591-5523
US

IV. Provider business mailing address

155 WHITE PLAINS RD
TARRYTOWN NY
10591-5523
US

V. Phone/Fax

Practice location:
  • Phone: 914-366-0500
  • Fax:
Mailing address:
  • Phone: 914-997-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number65590
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number314139
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: