Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | MD445723 | PA |
Y | 208200000X | Surgeon | 25MA09042500 | NJ |
Y | 208600000X | Surgeon | 25MA09042500 | NJ |
N | 208200000X | Surgeon | MD445723 | PA |
N | 208600000X | Surgeon | MD445723 | PA |
NPI | 1578714507 |
---|---|
Provider Name | Dr. Ebube A. Bakosi |
First Address | Boston, MA 02241-6457 |
Second Address | Pompton Plains, NJ 07444-1726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2008 |
Last Update Date | 06/05/2015 |