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General NPI Number Information
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NPI Number | 1477942597
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Entity Type | Individual
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Provider Name | NANNA OSEITUTU-EBANKS M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 30 HEMPSTEAD AVE STE 151
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4034
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Country | US
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Telephone | 646-838-3560
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Fax | 646-838-3569
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Provider Business Mailing Address
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Address Line | 488 ALLEN AVE
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City | BALDWIN
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State | NY
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Zip | 11510-3701
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Country | US
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Telephone | 347-743-3773
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 281669
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number | 281669
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License Number State | NY
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