Provider Demographics
NPI:1588328082
Name:EQUIPPED MIND PSYCHIATRY NP SERVICES PC
Entity type:Organization
Organization Name:EQUIPPED MIND PSYCHIATRY NP SERVICES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ESE
Authorized Official - Middle Name:P
Authorized Official - Last Name:ABOHWO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:914-803-3575
Mailing Address - Street 1:130 GLENWOOD AVE APT 15
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2640
Mailing Address - Country:US
Mailing Address - Phone:914-803-3575
Mailing Address - Fax:516-500-9533
Practice Address - Street 1:130 PONDFIELD RD STE 1
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-4016
Practice Address - Country:US
Practice Address - Phone:914-207-3373
Practice Address - Fax:516-500-9533
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EQUIPPED MIND PSYCHIATRY NP SERVICES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-29
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06862615Medicaid