Healthcare Provider Details

I. General information

NPI: 1790084507
Provider Name (Legal Business Name): ABIOLA A AGBOOLA RN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIOLA A AGBOOLA

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 TARGEE ST
STATEN ISLAND NY
10304-1926
US

IV. Provider business mailing address

194 TARGEE ST
STATEN ISLAND NY
10304-1926
US

V. Phone/Fax

Practice location:
  • Phone: 347-276-1280
  • Fax: 718-390-5166
Mailing address:
  • Phone: 347-276-1280
  • Fax: 718-390-5166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1343L001
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1343L001
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number403674
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number360383
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number403674
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number403674
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF000731
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1343L001
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1343L001
License Number StateNY
# 10
Primary TaxonomyN
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number1343L001
License Number StateNY
# 11
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number1343L001
License Number StateNY
# 12
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number1343L001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: