Provider Demographics
NPI:1487884318
Name:OBASEKI, EDEMA ALFRED
Entity type:Individual
Prefix:
First Name:EDEMA
Middle Name:ALFRED
Last Name:OBASEKI
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 1:93 SHOREVIEW DR APT 3
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1328
Mailing Address - Country:US
Mailing Address - Phone:347-965-9673
Mailing Address - Fax:
Practice Address - Street 1:93 SHOREVIEW DR APT 3
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1328
Practice Address - Country:US
Practice Address - Phone:347-965-9673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY613841163W00000X
NYF341120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty