Healthcare Provider Details

I. General information

NPI: 1992310411
Provider Name (Legal Business Name): CEDI MEDICAL OFFICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 GRAND CONCOURSE UNIT 1A-1B
BRONX NY
10458-2611
US

IV. Provider business mailing address

2940 GRAND CONCOURSE UNIT 1A-1B
BRONX NY
10458-2611
US

V. Phone/Fax

Practice location:
  • Phone: 718-220-0900
  • Fax: 718-733-6773
Mailing address:
  • Phone: 718-220-0900
  • Fax: 718-733-6773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KWABENA BOAKYE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 718-220-0900