Provider Demographics
NPI:1447396569
Name:ENABOSI, FELIX (PHD;OTR)
Entity Type:Individual
Prefix:DR
First Name:FELIX
Middle Name:
Last Name:ENABOSI
Suffix:
Gender:M
Credentials:PHD;OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 S BROADWAY FL 4
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3708
Mailing Address - Country:US
Mailing Address - Phone:914-968-5464
Mailing Address - Fax:
Practice Address - Street 1:30 S BROADWAY FL 4
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3708
Practice Address - Country:US
Practice Address - Phone:914-968-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003058-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQTW281Medicare ID - Type Unspecified
NYY38218Medicare UPIN