Canaan Medical LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

CANAAN MEDICAL LLC

Practice address

661 Cauldwell Ave
Bronx, NY 10455-1503

Phone

(973) 342-5593

NPI assigned

Mar 19, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kevin A Obi, MLP NURSE PRACTIONER

Title

Nurse

Phone

(973) 342-5593

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584576000000",
    "number": "1023644218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 SOMERSET ST APT 3B",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071034150",
            "telephone_number": "973-342-5593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "661 CAULDWELL AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104551503",
            "telephone_number": "973-342-5593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANAAN MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-19",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A",
        "authorized_official_last_name": "OBI",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "NURSE",
        "authorized_official_telephone_number": "973-342-5593",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MLP NURSE PRACTIONER"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTIONER",
            "identifier": "1679062640",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "EHR",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "661 Cauldwell Ave",
            "city": "Bronx",
            "state": "NY",
            "country_code": "US",
            "postal_code": "104551503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jessica Campoverde
• Kiana Campozano
• Joannie Campuzano Cepeda, L.AC
• Hector Campuzano
• Jorge Luis Camunas, M.D.
• Canaan Psychiatric and Addiction Services LLC
• Tanequa Canady
• Michelle Canales, REGISTER NURSE
• Jacob Daniel Canavan, MD
• Angela Cancel, LCSW

• Psychiatric/Mental Health Nurse Practitioner in Bronx, NY
• Providers in Bronx, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.