Healthcare Provider Details

I. General information

NPI: 1811307945
Provider Name (Legal Business Name): MARKSON AYEKU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22610 146TH AVE
SPRINGFIELD GARDENS NY
11413-3815
US

IV. Provider business mailing address

22610 146TH AVE
SPRINGFIELD GARDENS NY
11413-3815
US

V. Phone/Fax

Practice location:
  • Phone: 646-657-7653
  • Fax:
Mailing address:
  • Phone: 646-657-7653
  • Fax: 718-494-1095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number318297
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407396
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number781487
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number318297
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: