Provider Demographics
NPI:1497853451
Name:ABBEY-MENSAH, MICHAEL O (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:O
Last Name:ABBEY-MENSAH
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 1:322 NASSAU AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-6119
Mailing Address - Country:US
Mailing Address - Phone:718-485-2704
Mailing Address - Fax:516-385-9279
Practice Address - Street 1:437 MOTHER GASTON BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-7617
Practice Address - Country:US
Practice Address - Phone:718-485-2704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159078208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00865114Medicaid