1851379762 NPI number — MRS. EMILIA ADDO MSN RNC APRN BC FNP

Table of content: MR. AARON FOWLER (NPI 1053620955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851379762 NPI number — MRS. EMILIA ADDO MSN RNC APRN BC FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADDO
Provider First Name:
EMILIA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN RNC APRN BC FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADDO-BORTEY
Provider Other First Name:
EMILIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
F.N.P
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1851379762
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
616 BALIS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MULLICA HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08062-2849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 E 16TH ST
Provider Second Line Business Practice Location Address:
IRVING PLACE DIALYSIS UNIT
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-844-8612
Provider Business Practice Location Address Fax Number:
212-844-5885
Provider Enumeration Date:
01/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  F333767 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F 333767 . This is a "NYS LIC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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