Provider Demographics
NPI:1245548114
Name:ASIEDU, STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:ASIEDU
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 1:66 FISHER AVE
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2608
Mailing Address - Country:US
Mailing Address - Phone:914-207-4527
Mailing Address - Fax:
Practice Address - Street 1:1245B EDWARD GRANT HIGHWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3101
Practice Address - Country:US
Practice Address - Phone:917-801-4410
Practice Address - Fax:917-801-4413
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270635207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine