Provider Demographics
NPI:1154330371
Name:MINTAH, JOSEPH KYEI (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KYEI
Last Name:MINTAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:KYEI
Other - Last Name:MINTAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1922 MCGRAW AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7974
Mailing Address - Country:US
Mailing Address - Phone:718-829-7333
Mailing Address - Fax:718-863-0050
Practice Address - Street 1:1922 MCGRAW AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-7974
Practice Address - Country:US
Practice Address - Phone:718-829-7333
Practice Address - Fax:718-863-0050
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193750207R00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01500650Medicaid
NY01500650Medicaid
NY01500650Medicaid