Provider Demographics
NPI:1992121206
Name:YEBOAH, EDMOND
Entity type:Individual
Prefix:
First Name:EDMOND
Middle Name:
Last Name:YEBOAH
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 1:120 CARVER LOOP APT 11C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-2914
Mailing Address - Country:US
Mailing Address - Phone:917-615-9780
Mailing Address - Fax:
Practice Address - Street 1:120 CARVER LOOP APT 11C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2914
Practice Address - Country:US
Practice Address - Phone:917-615-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY680475163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse