Healthcare Provider Details

I. General information

NPI: 1457687394
Provider Name (Legal Business Name): EDWARD KWADWO AMANKWAAH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 GRASSLANDS RD
VALHALLA NY
10595-1652
US

IV. Provider business mailing address

68 S SERVICE RD SUITE 350
MELVILLE NY
11747-2354
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-7857
  • Fax: 914-493-8439
Mailing address:
  • Phone: 516-945-3000
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number542759
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: