Provider Demographics
NPI:1003228594
Name:DARKWA, FRED (NP)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:DARKWA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RIVERDALE AVE APT 8A
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-4625
Mailing Address - Country:US
Mailing Address - Phone:914-216-5718
Mailing Address - Fax:
Practice Address - Street 1:2006 MADISON AVE FL 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1217
Practice Address - Country:US
Practice Address - Phone:914-216-5718
Practice Address - Fax:845-633-5765
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY679006163W00000X
NYF403338363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse