Provider Demographics
NPI:1851379762
Name:ADDO, EMILIA (MSN RNC APRN BC FNP)
Entity Type:Individual
Prefix:MRS
First Name:EMILIA
Middle Name:
Last Name:ADDO
Suffix:
Gender:F
Credentials:MSN RNC APRN BC FNP
Other - Prefix:MRS
Other - First Name:EMILIA
Other - Middle Name:
Other - Last Name:ADDO-BORTEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:616 BALIS DR
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 E 16TH ST
Practice Address - Street 2:IRVING PLACE DIALYSIS UNIT
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2103
Practice Address - Country:US
Practice Address - Phone:212-844-8612
Practice Address - Fax:212-844-5885
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333767363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF 333767OtherNYS LIC
NYF 333767OtherNYS LIC