Organization
SISCK INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GODFREY U MBONU MD (PRESIDENT)
(212) 749-2482
Entity
Organization
Contact information
Practice address
914A COLUMBUS AVE, NEW YORK, NY 10025-4040
(212) 749-2482
(212) 749-2484
Mailing address
914A COLUMBUS AVE, NEW YORK, NY 10025-4040
(212) 749-2482
(212) 749-2484
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
226508
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02616613
—
NY
Enumeration date
02/16/2007
Last updated
08/22/2020
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