Organization Name: | SISCK INC |
NPI Number: | 1699819433 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GODFREY U MBONU (PRESIDENT) |
Mailing Address: | 914a Columbus Ave New York |
State: | NY US |
Postal Code: | 100254040 |
Phone Number: | 2127492482 |
Fax Number: | 2127492484 |
NPI Enumeration Date: | 02/16/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2084A0401X |
License Number: | 226508 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Psychiatry & Neurology |
Taxonomy Specialization: | Addiction Medicine |
Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |