Provider Demographics
NPI:1679668370
Name:ESSIEN, RALPH B (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:B
Last Name:ESSIEN
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 1:69 MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-4609
Mailing Address - Country:US
Mailing Address - Phone:914-636-1967
Mailing Address - Fax:914-636-6083
Practice Address - Street 1:25 COLIGNI AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-2605
Practice Address - Country:US
Practice Address - Phone:914-636-1967
Practice Address - Fax:914-636-6083
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197326-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01532190Medicaid
NYF99362Medicare UPIN
NY01532190Medicaid