Provider Demographics
NPI:1457629941
Name:ANUKWARE KETOSUGBO, MD, PC
Entity Type:Organization
Organization Name:ANUKWARE KETOSUGBO, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANUKWARE
Authorized Official - Middle Name:K
Authorized Official - Last Name:KETOSUGBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-622-1301
Mailing Address - Street 1:PO BOX 5619
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5619
Mailing Address - Country:US
Mailing Address - Phone:718-622-1301
Mailing Address - Fax:718-622-1367
Practice Address - Street 1:20 PLAZA STEET EAST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238
Practice Address - Country:US
Practice Address - Phone:718-622-1301
Practice Address - Fax:718-622-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1475452086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty