Healthcare Provider Details

I. General information

NPI: 1649028945
Provider Name (Legal Business Name): JANELLE A DJOMOAH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BENCHLEY PL APT 28L
BRONX NY
10475-3319
US

IV. Provider business mailing address

100 BENCHLEY PL APT 28L
BRONX NY
10475-3319
US

V. Phone/Fax

Practice location:
  • Phone: 929-231-9037
  • Fax:
Mailing address:
  • Phone: 929-231-9037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number868721
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: