Basic Information
Provider Information
NPI: 1083334452
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ASAFU-ADJAYE
FirstName: KWAKU
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: APN (PMHNP)
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 306 BOYDEN AVE FL 1
Address2:  
City: MAPLEWOOD
State: NJ
PostalCode: 070403010
CountryCode: US
TelephoneNumber: 2016998024
FaxNumber:  
Practice Location
Address1: 59 KOCH AVE
Address2:  
City: MORRIS PLAINS
State: NJ
PostalCode: 079504400
CountryCode: US
TelephoneNumber: 9735381800
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/29/2022
LastUpdateDate: 08/29/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/28/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808X26NJ01318400NJY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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