Provider Demographics
NPI:1083689673
Name:GIWA, AL O (MD, MBA, MBE)
Entity Type:Individual
Prefix:
First Name:AL
Middle Name:O
Last Name:GIWA
Suffix:
Gender:M
Credentials:MD, MBA, MBE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CLIFTON PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1202
Mailing Address - Country:US
Mailing Address - Phone:718-483-6333
Mailing Address - Fax:
Practice Address - Street 1:24 CLIFTON PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-1202
Practice Address - Country:US
Practice Address - Phone:718-483-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043715207P00000X
NY210159207P00000X
NJ25MA08213300207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01825052Medicaid
NY01825052Medicaid
NYJ400002664Medicare Oscar/Certification