Provider Demographics
NPI:1902216229
Name:SAMUEL AKUOKU PHYSICIAN PLLC
Entity Type:Organization
Organization Name:SAMUEL AKUOKU PHYSICIAN PLLC
Other - Org Name:LAURELTON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:BOATENG
Authorized Official - Last Name:AKUOKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-949-6433
Mailing Address - Street 1:22414 MERRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2023
Mailing Address - Country:US
Mailing Address - Phone:718-949-6433
Mailing Address - Fax:718-949-0331
Practice Address - Street 1:22414 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2023
Practice Address - Country:US
Practice Address - Phone:718-949-6433
Practice Address - Fax:718-949-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178587261Q00000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty