Healthcare Provider Details

I. General information

NPI: 1225306509
Provider Name (Legal Business Name): IGNATIUS A GBADUO RN, MSN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 W 14TH ST FL 1
NEW YORK NY
10014-5002
US

IV. Provider business mailing address

320 W 30TH ST 6 B
NEW YORK NY
10001-2710
US

V. Phone/Fax

Practice location:
  • Phone: 646-638-2015
  • Fax: 646-638-1842
Mailing address:
  • Phone: 518-577-7814
  • Fax: 646-638-1842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337009
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: