Healthcare Provider Details

I. General information

NPI: 1538093158
Provider Name (Legal Business Name): LOIS NMACHI ABOAJA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 CLARKSON AVE
BROOKLYN NY
11203-2199
US

IV. Provider business mailing address

21915 130TH DR
SPRINGFIELD GARDENS NY
11413-1220
US

V. Phone/Fax

Practice location:
  • Phone: 718-221-7700
  • Fax:
Mailing address:
  • Phone: 347-901-7192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN11376-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: