Provider Demographics
NPI:1720663826
Name:ANKOMAH, OWUSU
Entity type:Individual
Prefix:
First Name:OWUSU
Middle Name:
Last Name:ANKOMAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 HUTCHINSON RIVER PKWY E APT 22H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5433
Mailing Address - Country:US
Mailing Address - Phone:917-832-3046
Mailing Address - Fax:
Practice Address - Street 1:4120 HUTCHINSON RIVER PKWY E APT 22H
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5433
Practice Address - Country:US
Practice Address - Phone:917-832-3046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY792136163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse