Provider Demographics
NPI:1548582141
Name:EDEM, JOSEPHINE MFON (NP)
Entity Type:Individual
Prefix:MISS
First Name:JOSEPHINE
Middle Name:MFON
Last Name:EDEM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MFON
Other - Middle Name:
Other - Last Name:EDEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1456 FULTON STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216
Mailing Address - Country:US
Mailing Address - Phone:718-636-4500
Mailing Address - Fax:347-296-8310
Practice Address - Street 1:1456 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2505
Practice Address - Country:US
Practice Address - Phone:718-636-4500
Practice Address - Fax:347-296-8310
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341228363LF0000X
NY620252163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05401345Medicaid