Healthcare Provider Details

I. General information

NPI: 1770023954
Provider Name (Legal Business Name): ABIGAIL OLUFEAGBA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY WOODHULL MEDICAL CENTER
BROOKLYN NY
11206
US

IV. Provider business mailing address

1254 E 83RD ST
BROOKLYN NY
11236-4933
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-8000
  • Fax:
Mailing address:
  • Phone: 347-462-4307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF307527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: