Provider Demographics
NPI:1366744120
Name:OSEI-TUTU DERMATOLOGY PC
Entity type:Organization
Organization Name:OSEI-TUTU DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER OF PC
Authorized Official - Prefix:DR
Authorized Official - First Name:ACHIAMAH
Authorized Official - Middle Name:
Authorized Official - Last Name:OSEI-TUTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-507-7555
Mailing Address - Street 1:560 NORTHERN BLVD
Mailing Address - Street 2:SUITE 204A
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5118
Mailing Address - Country:US
Mailing Address - Phone:516-506-0025
Mailing Address - Fax:516-506-0032
Practice Address - Street 1:560 NORTHERN BLVD
Practice Address - Street 2:SUITE 204A
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5118
Practice Address - Country:US
Practice Address - Phone:516-506-0025
Practice Address - Fax:516-506-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251302261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty