Provider Demographics
NPI:1225105083
Name:MADU, EDNAH NDIDI (NP)
Entity Type:Individual
Prefix:MS
First Name:EDNAH
Middle Name:NDIDI
Last Name:MADU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9304 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369-1538
Mailing Address - Country:US
Mailing Address - Phone:347-623-2400
Mailing Address - Fax:
Practice Address - Street 1:80TH ST & 41ST AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-2424
Practice Address - Fax:718-334-5958
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335089363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care