=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558460550
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMMANUEL K. OHEMENG JR. D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5922 N BROAD ST FL 1
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19141-1802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-224-7778
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 ASBURY AVE
-----------------------------------------------------
City | MELROSE PARK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19027-2918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | SC 003524 L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------