Provider Demographics
NPI:1437384187
Name:FOFANA, ADJA
Entity Type:Individual
Prefix:
First Name:ADJA
Middle Name:
Last Name:FOFANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MCCLELLAN ST
Mailing Address - Street 2:7A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-4807
Mailing Address - Country:US
Mailing Address - Phone:646-420-0133
Mailing Address - Fax:
Practice Address - Street 1:215 MCCLELLAN ST
Practice Address - Street 2:7A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-4807
Practice Address - Country:US
Practice Address - Phone:646-420-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295488-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse