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General NPI Number Information
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NPI Number | 1659639730
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Entity Type | Organization
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Legal Business Name | OBOSA MEDICAL SERVICES,PC
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 04/26/2012
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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 | 11 GOLDEN RD
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City | MONTEBELLO
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State | NY
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Zip | 10901-3220
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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 | OWNER
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Name | DR. FRANCIS O 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 | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 193487
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License Number State | NY
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