Provider Demographics
NPI:1447308697
Name:OSEI-TUTU, PRUDENCE A SR (MD)
Entity type:Individual
Prefix:DR
First Name:PRUDENCE
Middle Name:A
Last Name:OSEI-TUTU
Suffix:SR
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3301
Mailing Address - Country:US
Mailing Address - Phone:718-826-1355
Mailing Address - Fax:718-462-3940
Practice Address - Street 1:84 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3301
Practice Address - Country:US
Practice Address - Phone:718-826-1355
Practice Address - Fax:718-462-3940
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1455012080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7184623940Other3267