Healthcare Provider Details

I. General information

NPI: 1093653677
Provider Name (Legal Business Name): DR. EDWARD OFORI ADDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 DE KRUIF PL APT 28J
BRONX NY
10475-2215
US

IV. Provider business mailing address

140 DE KRUIF PL APT 28J
BRONX NY
10475-2215
US

V. Phone/Fax

Practice location:
  • Phone: 718-581-4139
  • Fax: 718-581-4139
Mailing address:
  • Phone: 718-581-4139
  • Fax: 718-581-4139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: