Provider Demographics
NPI:1508802182
Name:AGYEMANG, KURAGU (MD)
Entity Type:Individual
Prefix:
First Name:KURAGU
Middle Name:
Last Name:AGYEMANG
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 1:753 CLASSON AVE
Mailing Address - Street 2:SUITE L-L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4647
Mailing Address - Country:US
Mailing Address - Phone:718-789-1261
Mailing Address - Fax:718-725-7307
Practice Address - Street 1:753 CLASSON AVE
Practice Address - Street 2:SUITE L-L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4647
Practice Address - Country:US
Practice Address - Phone:718-789-1261
Practice Address - Fax:718-725-7307
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192805207W00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01457116Medicaid
NY01457116Medicaid
F74847Medicare UPIN