Provider Demographics
NPI:1659639730
Name:OBOSA MEDICAL SERVICES,PC
Entity Type:Organization
Organization Name:OBOSA MEDICAL SERVICES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:O
Authorized Official - Last Name:AGBONKPOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-530-2323
Mailing Address - Street 1:11 GOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3220
Mailing Address - Country:US
Mailing Address - Phone:914-530-2323
Mailing Address - Fax:914-530-2320
Practice Address - Street 1:140 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2515
Practice Address - Country:US
Practice Address - Phone:914-530-2323
Practice Address - Fax:914-530-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193487208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20N151Medicare UPIN