Healthcare Provider Details

I. General information

NPI: 1013412808
Provider Name (Legal Business Name): JEDIDAH OWUSU NUAMAH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CENTEROCK RD
WEST NYACK NY
10994-2215
US

IV. Provider business mailing address

2265 5TH AVE APT 12D
NEW YORK NY
10037-2028
US

V. Phone/Fax

Practice location:
  • Phone: 845-348-1100
  • Fax:
Mailing address:
  • Phone: 646-204-8208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number320819
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number80308
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: