MEDICARE: DR. PRISCILLA AMPONSAH DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA01436400	NJ

General Provider Information

NPI Number	:	1275873598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRISCILLA AMPONSAH DPT

Provider Business Mailing Address
First Line	:	111 VAUGHAN DR
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-3469
Country	:	US
Telephone Number	:	917-767-7166
Fax Number	:

Provider Business Practice Location Address
First Line	:	559 SUMMIT AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2701
Country	:	US
Telephone Number	:	973-653-5031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2013
Last Update Date	:	02/23/2013

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