1003292988 NPI number — ABOSEDE ADETOUN THOMASOGUNDEINDE LPN

Table of content: ABOSEDE ADETOUN THOMASOGUNDEINDE LPN (NPI 1003292988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003292988 NPI number — ABOSEDE ADETOUN THOMASOGUNDEINDE LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMASOGUNDEINDE
Provider First Name:
ABOSEDE
Provider Middle Name:
ADETOUN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003292988
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 N CORONA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY STREAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11580-2602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-409-9322
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 MAIN ST
Provider Second Line Business Practice Location Address:
APT 241
Provider Business Practice Location Address City Name:
HEMPSTEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11550-1427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-409-9322
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  315975 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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