Basic Information
| Provider Information | |||||||||
| NPI: | 1396103982 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GO AFRICA HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1760 2ND AVE | ||||||||
| Address2: | SUITE 22C | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 101285329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9174474922 | ||||||||
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| Practice Location | |||||||||
| Address1: | 543 W 141ST ST | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100317026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9174474922 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2016 | ||||||||
| LastUpdateDate: | 02/10/2016 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | SAMUEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9174474922 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 182228 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.