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General NPI Number Information
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NPI Number | 1023644218
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Entity Type | Organization
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Legal Business Name | CANAAN MEDICAL LLC
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 661 CAULDWELL AVE
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City | BRONX
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State | NY
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Zip | 10455-1503
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Country | US
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Telephone | 973-342-5593
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Fax |
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Provider Business Mailing Address
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Address Line | 4 SOMERSET ST APT 3B
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City | NEWARK
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State | NJ
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Zip | 07103-4150
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Country | US
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Telephone | 973-342-5593
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Fax |
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Authorized Official
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Title or Position | NURSE
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Name | MR. KEVIN A OBI
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Credential | MLP NURSE PRACTIONER
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Telephone | 973-342-5593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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