Healthcare Provider Details

I. General information

NPI: 1578485900
Provider Name (Legal Business Name): NESTOR HOUNKPATIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 GREENE LN
CHERRY HILL NJ
08003-1146
US

IV. Provider business mailing address

1338 GREENE LN
CHERRY HILL NJ
08003-1146
US

V. Phone/Fax

Practice location:
  • Phone: 862-252-5680
  • Fax:
Mailing address:
  • Phone: 862-252-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NR22515600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: