Provider Demographics
NPI:1154819811
Name:ADJIN, EMMANUEL KWASI
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:KWASI
Last Name:ADJIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 HAWKINS PL STE 209
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1127
Mailing Address - Country:US
Mailing Address - Phone:718-568-8480
Mailing Address - Fax:718-550-8874
Practice Address - Street 1:100 ENTERPRISE DR STE 301
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-2129
Practice Address - Country:US
Practice Address - Phone:718-568-8480
Practice Address - Fax:718-550-8874
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00819900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health