Healthcare Provider Details

I. General information

NPI: 1336681113
Provider Name (Legal Business Name): ADEKEMI IDOWU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 WESTMINSTER RD
NORTH BALDWIN NY
11510-1039
US

IV. Provider business mailing address

664 WESTMINSTER RD
NORTH BALDWIN NY
11510-1039
US

V. Phone/Fax

Practice location:
  • Phone: 347-399-9056
  • Fax:
Mailing address:
  • Phone: 347-399-9056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number313969
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: