Provider Demographics
NPI:1528536471
Name:OSEITUTU FAMILY MEDICAL PLLC
Entity Type:Organization
Organization Name:OSEITUTU FAMILY MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSEITUTU-EBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-743-3773
Mailing Address - Street 1:488 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3701
Mailing Address - Country:US
Mailing Address - Phone:347-743-3773
Mailing Address - Fax:
Practice Address - Street 1:165 N VILLAGE AVE STE 151
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3761
Practice Address - Country:US
Practice Address - Phone:646-838-3560
Practice Address - Fax:646-838-3569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty