Provider Demographics
NPI:1710029228
Name:BINEY-AMISSAH, DOMINIC (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:
Last Name:BINEY-AMISSAH
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 1:726 BROADWAY FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-9616
Mailing Address - Country:US
Mailing Address - Phone:212-443-1000
Mailing Address - Fax:212-443-1151
Practice Address - Street 1:519 W 114TH ST
Practice Address - Street 2:MAIL CODE 3601
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-7036
Practice Address - Country:US
Practice Address - Phone:212-854-9842
Practice Address - Fax:212-854-9851
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232530207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I19771Medicare UPIN