Provider Demographics
NPI:1134994783
Name:AFFUL, EDDIE BENNETT (NP)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:BENNETT
Last Name:AFFUL
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Gender:
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:120 ELGAR PL APT 33B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5105
Mailing Address - Country:US
Mailing Address - Phone:908-265-6246
Mailing Address - Fax:866-531-5104
Practice Address - Street 1:140 CASALS PL UNIT B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-3202
Practice Address - Country:US
Practice Address - Phone:347-202-7572
Practice Address - Fax:866-531-5104
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF352690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily