# CANAAN MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023644218
- **Authorized official:** MR. KEVIN A OBI MLP NURSE PRACTIONER (NURSE)
- **Authorized official phone:** (973) 342-5593

## Contact information

- **Practice address:** 661 CAULDWELL AVE, BRONX, NY 10455-1503
- **Practice address phone:** (973) 342-5593
- **Mailing address:** 4 SOMERSET ST APT 3B, NEWARK, NJ 07103-4150
- **Mailing address phone:** (973) 342-5593

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/19/2020
- **Last updated:** 03/19/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1679062640 | NURSE PRACTIONER | NY |