Provider Demographics
NPI:1710181771
Name:EBENEZER KOJO ESSUMAN MD PLLC
Entity Type:Organization
Organization Name:EBENEZER KOJO ESSUMAN MD PLLC
Other - Org Name:UNIONDALE MEDICAL MULTI-SPECIALTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EBENEZER
Authorized Official - Middle Name:KOJO
Authorized Official - Last Name:ESSUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-670-6106
Mailing Address - Street 1:451 UNIONDALE AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-2232
Mailing Address - Country:US
Mailing Address - Phone:516-670-6106
Mailing Address - Fax:516-485-2229
Practice Address - Street 1:451 UNIONDALE AVE
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-2232
Practice Address - Country:US
Practice Address - Phone:516-670-6106
Practice Address - Fax:516-485-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty