Provider Demographics
NPI:1306296561
Name:STEPHEN ASIEDU MEDICAL PRACTICE, P.C.
Entity type:Organization
Organization Name:STEPHEN ASIEDU MEDICAL PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASIEDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-444-1583
Mailing Address - Street 1:66 FISHER AVE
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2608
Mailing Address - Country:US
Mailing Address - Phone:917-801-4410
Mailing Address - Fax:
Practice Address - Street 1:1409 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-1831
Practice Address - Country:US
Practice Address - Phone:917-444-1583
Practice Address - Fax:718-681-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty