Healthcare Provider Details

I. General information

NPI: 1265088983
Provider Name (Legal Business Name): GIFTY BAFFOUR-ADDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2019
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169-59 137TH AVE
ROCHDALE NY
11434
US

IV. Provider business mailing address

55 WATER STREET 2ND FLOOR CRED DEPT
NEW YORK NY
10041-0010
US

V. Phone/Fax

Practice location:
  • Phone: 718-525-5600
  • Fax: 718-559-5285
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344207
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: