Healthcare Provider Details

I. General information

NPI: 1134678444
Provider Name (Legal Business Name): PARTRISON BAYONG NJONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6021 67TH AVE APT 1
RIVERDALE MD
20737-1765
US

IV. Provider business mailing address

6021 67TH AVE APT 1
RIVERDALE MD
20737-1765
US

V. Phone/Fax

Practice location:
  • Phone: 240-470-2778
  • Fax:
Mailing address:
  • Phone: 240-470-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: