Provider Demographics
NPI:1922157015
Name:NTIRI, AARON ANTWI YAW (MD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:ANTWI YAW
Last Name:NTIRI
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 1:374 OLD BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2611
Mailing Address - Country:US
Mailing Address - Phone:631-754-7729
Mailing Address - Fax:631-754-7729
Practice Address - Street 1:374 OLD BRIDGE RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-2611
Practice Address - Country:US
Practice Address - Phone:631-754-7729
Practice Address - Fax:631-754-7729
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00777413Medicaid
NY00777413Medicaid
NY97A921Medicare ID - Type Unspecified