Healthcare Provider Details

I. General information

NPI: 1578267910
Provider Name (Legal Business Name): HOPELYDIA C AGBO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OF 2631 MERRICK ROAD, SUITE 302
BELLMORE NY
11710
US

IV. Provider business mailing address

10 OAKWOOD AVE
BLOOMFIELD NJ
07003-6025
US

V. Phone/Fax

Practice location:
  • Phone: 516-308-4966
  • Fax:
Mailing address:
  • Phone: 908-404-2806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: