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General NPI Number Information
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NPI Number | 1992310411
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Entity Type | Organization
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Legal Business Name | CEDI MEDICAL OFFICE PLLC
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Dates
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Enumeration Date | 09/11/2020
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 2940 GRAND CONCOURSE UNIT 1A-1B
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City | BRONX
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State | NY
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Zip | 10458-2611
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Country | US
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Telephone | 718-220-0900
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Fax | 718-733-6773
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Provider Business Mailing Address
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Address Line | 2940 GRAND CONCOURSE UNIT 1A-1B
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City | BRONX
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State | NY
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Zip | 10458-2611
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Country | US
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Telephone | 718-220-0900
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Fax | 718-733-6773
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. KWABENA BOAKYE
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Credential | MD
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Telephone | 718-220-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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