Provider Demographics
NPI:1962595298
Name:KWABENA OWUSU-DAPAAH, MD PC.
Entity type:Organization
Organization Name:KWABENA OWUSU-DAPAAH, MD PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KWABENA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWUSU-DAPAAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-246-1960
Mailing Address - Street 1:710 EASTON AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1855
Mailing Address - Country:US
Mailing Address - Phone:732-246-1960
Mailing Address - Fax:732-246-3141
Practice Address - Street 1:710 EASTON AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1855
Practice Address - Country:US
Practice Address - Phone:732-246-1960
Practice Address - Fax:732-246-3141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO60340261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6402909Medicaid
DA-883345Medicare ID - Type Unspecified
G30432Medicare UPIN