Provider Demographics
NPI:1699832964
Name:AGYEMANG, EMMANUEL APPIAH (NP)
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:APPIAH
Last Name:AGYEMANG
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MARTHA ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-6211
Mailing Address - Country:US
Mailing Address - Phone:516-608-1111
Mailing Address - Fax:516-608-1111
Practice Address - Street 1:25302 147TH AVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2541
Practice Address - Country:US
Practice Address - Phone:718-341-3535
Practice Address - Fax:718-341-1730
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304472-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health