Provider Demographics
NPI:1487723243
Name:OWUSU, SOLOMON (MD)
Entity type:Individual
Prefix:
First Name:SOLOMON
Middle Name:
Last Name:OWUSU
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 1:559 W SIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1617
Mailing Address - Country:US
Mailing Address - Phone:201-432-5300
Mailing Address - Fax:201-432-4630
Practice Address - Street 1:559 W SIDE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1617
Practice Address - Country:US
Practice Address - Phone:201-432-5300
Practice Address - Fax:201-432-4630
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05988100207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6029612Medicaid
512106Medicare ID - Type Unspecified
NJ6029612Medicaid