Basic Information
| Provider Information | |||||||||
| NPI: | 1447308697 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSEI-TUTU | ||||||||
| FirstName: | PRUDENCE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 84 LINDEN BLVD | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112263301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188261355 | ||||||||
| FaxNumber: | 7184623940 | ||||||||
| Practice Location | |||||||||
| Address1: | 84 LINDEN BLVD | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112263301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188261355 | ||||||||
| FaxNumber: | 7184623940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | 145501 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7184623940 | 01 | NY | 3267 | OTHER |