Healthcare Provider Details

I. General information

NPI: 1083282933
Provider Name (Legal Business Name): WISDOM BAIDOO ADDAE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/16/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NOTT ST
SCHENECTADY NY
12308-2489
US

IV. Provider business mailing address

3 CENTURY DR
PARSIPPANY NJ
07054-4610
US

V. Phone/Fax

Practice location:
  • Phone: 518-243-4000
  • Fax:
Mailing address:
  • Phone: 215-384-7432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: