Healthcare Provider Details

I. General information

NPI: 1023509122
Provider Name (Legal Business Name): MR. PAUL ANICET NJOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ORCHARD DR
GAITHERSBURG MD
20878-2222
US

IV. Provider business mailing address

64 ORCHARD DR
GAITHERSBURG MD
20878-2222
US

V. Phone/Fax

Practice location:
  • Phone: 240-690-1671
  • Fax:
Mailing address:
  • Phone: 240-690-1671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13622
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: