Provider Demographics
NPI:1891921383
Name:USUKUMAH E. USUKUMAH MEDICAL, PLLC
Entity Type:Organization
Organization Name:USUKUMAH E. USUKUMAH MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OBSTETRICS & GYNECOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:USUKUMAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:USUKUMAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-602-3788
Mailing Address - Street 1:560 HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-4376
Mailing Address - Country:US
Mailing Address - Phone:718-602-3788
Mailing Address - Fax:718-552-2411
Practice Address - Street 1:478 HALSEY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1002
Practice Address - Country:US
Practice Address - Phone:718-602-3788
Practice Address - Fax:718-552-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY565D12Medicare PIN