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General NPI Number Information
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NPI Number | 1487884318
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Entity Type | Individual
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Provider Name | EDEMA ALFRED OBASEKI
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Gender | Male
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Dates
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Enumeration Date | 07/27/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 93 SHOREVIEW DR APT 3
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City | YONKERS
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State | NY
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Zip | 10710-1328
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Country | US
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Telephone | 347-965-9673
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Fax |
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Provider Business Mailing Address
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Address Line | 93 SHOREVIEW DR APT 3
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City | YONKERS
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State | NY
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Zip | 10710-1328
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Country | US
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Telephone | 347-965-9673
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 613841
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F341120
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License Number State | NY
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