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General NPI Number Information
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NPI Number | 1194055012
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Entity Type | Organization
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Legal Business Name | OBOSA MEDICAL CARE, P.L.L.C.
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Dates
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Enumeration Date | 12/29/2009
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Last Update Date | 12/29/2009
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Provider Practice Location Address
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Address Line | 140 STEVENS AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2515
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Country | US
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Telephone | 914-530-2323
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Fax | 914-530-2320
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Provider Business Mailing Address
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Address Line | 140 STEVENS AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2515
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Country | US
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Telephone | 914-530-2323
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Fax | 914-530-2320
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Authorized Official
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Title or Position | CEO
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Name | FRANCIS AGBONKPOLO
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Credential | M.D.
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Telephone | 914-530-2323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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