Provider Demographics
NPI:1619845690
Name:DR. OSAFRADU OPAM MD, PC
Entity type:Organization
Organization Name:DR. OSAFRADU OPAM MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OSAFRADU
Authorized Official - Middle Name:
Authorized Official - Last Name:OPAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-698-3732
Mailing Address - Street 1:11572 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1028
Mailing Address - Country:US
Mailing Address - Phone:718-276-8666
Mailing Address - Fax:718-276-4158
Practice Address - Street 1:9713 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2523
Practice Address - Country:US
Practice Address - Phone:929-594-4801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-29
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty