Healthcare Provider Details

I. General information

NPI: 1891638904
Provider Name (Legal Business Name): ADIDJATOU CHARIFOU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415EAST 157TH STREET APT 2K
BRONX NY
10451
US

IV. Provider business mailing address

415EAST 157TH STREET APT 2K
BRONX NY
10451
US

V. Phone/Fax

Practice location:
  • Phone: 347-331-6615
  • Fax:
Mailing address:
  • Phone: 347-331-6615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number202572767
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: