Healthcare Provider Details

I. General information

NPI: 1588428064
Provider Name (Legal Business Name): ANDREW KUFORIJI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CARL PL
NEW WINDSOR NY
12553-5952
US

IV. Provider business mailing address

2017 FULTON ST APT 2
BROOKLYN NY
11233-4294
US

V. Phone/Fax

Practice location:
  • Phone: 929-602-6813
  • Fax:
Mailing address:
  • Phone: 929-602-6813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN2277178
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: