Provider Demographics
NPI:1497741060
Name:ESSUMAN, EBENEZER KOJO (MD)
Entity Type:Individual
Prefix:
First Name:EBENEZER
Middle Name:KOJO
Last Name:ESSUMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 UNIONDALE AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-2232
Mailing Address - Country:US
Mailing Address - Phone:516-485-2277
Mailing Address - Fax:516-485-2229
Practice Address - Street 1:451 UNIONDALE AVE
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-2232
Practice Address - Country:US
Practice Address - Phone:516-485-2277
Practice Address - Fax:516-485-2229
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1798012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01231OtherGHI MCR
NY01457056Medicaid
NY01231OtherGHI MCR
NY01457056Medicaid