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General NPI Number Information
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NPI Number | 1053719088
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Entity Type | Individual
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Provider Name | MAXWELL OPOKU KORANTENG
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Gender | Male
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 484 HAWTHORNE AVE APT 4N
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City | YONKERS
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State | NY
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Zip | 10705-3420
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Country | US
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Telephone | 914-312-7063
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Fax |
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Provider Business Mailing Address
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Address Line | 484 HAWTHORNE AVE APT 4N
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City | YONKERS
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State | NY
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Zip | 10705-3420
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Country | US
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Telephone | 914-312-7063
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 17015
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 694530
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License Number State | NY
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