MEDICARE: MRS. EMILIA ADDO MSN RNC APRN BC FNP

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	363L00000X	Nurse Practitioner	F333767	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F 333767	OTHER	NY	NYS LIC

General Provider Information

NPI Number	:	1851379762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILIA ADDO MSN RNC APRN BC FNP

Provider Business Mailing Address
First Line	:	616 BALIS DR
Second Line	:
City	:	MULLICA HILL
State	:	NJ
Zip	:	08062-2849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 E 16TH ST
Second Line	:	IRVING PLACE DIALYSIS UNIT
City	:	NEW YORK
State	:	NY
Zip	:	10003-2103
Country	:	US
Telephone Number	:	212-844-8612
Fax Number	:	212-844-5885

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	03/07/2023

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