Provider Demographics
NPI:1316249766
Name:ATANDA, AKEEM A (MD)
Entity type:Individual
Prefix:
First Name:AKEEM
Middle Name:A
Last Name:ATANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 BROOKDALE PLZ STE 666
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3139
Mailing Address - Country:US
Mailing Address - Phone:718-240-7143
Mailing Address - Fax:718-240-5808
Practice Address - Street 1:1 BROOKDALE PLZ STE 222
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-6213
Practice Address - Fax:718-240-5808
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2020-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2675932086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03827089Medicaid
NY03827089Medicaid