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General NPI Number Information
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NPI Number | 1538448501
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Entity Type | Individual
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Provider Name | MR. MICHAEL OTIBU ABOAGYE
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Gender | Male
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Dates
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Enumeration Date | 08/09/2011
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 33 INDEPENDENCE WAY
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City | MILLER PLACE
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State | NY
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Zip | 11764-2337
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Country | US
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Telephone | 646-420-4475
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Fax |
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Provider Business Mailing Address
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Address Line | 77 WAVERLY AVE APARTMENT 118
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City | PATCHOGUE
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State | NY
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Zip | 11772-2188
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Country | US
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Telephone | 646-420-4475
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 649259
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 345351
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License Number State | NY
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