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General NPI Number Information
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NPI Number | 1376879049
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Entity Type | Organization
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Legal Business Name | PARK WEST MEDICAL ASSOCIATE PLLC
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Dates
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Enumeration Date | 10/30/2009
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 15 W 84TH ST 1J
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City | NEW YORK
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State | NY
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Zip | 10024-4703
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Country | US
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Telephone | 212-362-3020
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Fax | 212-362-3020
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Provider Business Mailing Address
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Address Line | 15 W 84TH ST 1J
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City | NEW YORK
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State | NY
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Zip | 10024-4703
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Country | US
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Telephone | 212-362-3020
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Fax | 212-362-3020
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Authorized Official
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Title or Position | OWNER
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Name | OBUNIKE O. EDOKWE
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Credential | M.D.
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Telephone | 917-940-2386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 180533
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License Number State | NY
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