=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497941827
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADOMFEH HEALTHCARE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2007
-----------------------------------------------------
Last Update Date | 06/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 634 WESTERN AVE STE 1
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12203-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-482-1988
-----------------------------------------------------
Fax | 518-482-2153
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 634 WESTERN AVE STE 1
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12203-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-482-1988
-----------------------------------------------------
Fax | 518-482-2153
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PHYSICIAN
-----------------------------------------------------
Name | DR. CHARLES N ADOMFEH
-----------------------------------------------------
Credential | MD, PHD, FACP
-----------------------------------------------------
Telephone | 518-482-1988
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 207948
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------