MEDICARE: CHARLES EDUSEI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F338710-1	NY

General Provider Information

NPI Number	:	1215345392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES EDUSEI

Provider Business Mailing Address
First Line	:	8 FORDHAM HILL OVAL APT 10G
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-4807
Country	:	US
Telephone Number	:	646-319-5561
Fax Number	:

Provider Business Practice Location Address
First Line	:	1280 GIVAN AVE
Second Line	:	GEVANS MEDICAL PRACTICE
City	:	BRONX
State	:	NY
Zip	:	10469
Country	:	US
Telephone Number	:	347-449-5936
Fax Number	:	347-449-5937

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2014
Last Update Date	:	08/01/2014

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Directions to “ CHARLES EDUSEI ” Practice Location

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