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General NPI Number Information
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NPI Number | 1437516069
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Entity Type | Organization
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Legal Business Name | NISSI DIABETES CARE NP-ADULT HEALTH P.C.
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Dates
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Enumeration Date | 01/27/2016
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Last Update Date | 01/27/2016
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Provider Practice Location Address
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Address Line | 437 OLD COUNTRY RD
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City | MELVILLE
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State | NY
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Zip | 11747-1819
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Country | US
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Telephone | 516-205-2430
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Fax |
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Provider Business Mailing Address
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Address Line | 437 OLD COUNTRY RD
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City | MELVILLE
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State | NY
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Zip | 11747-1819
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Country | US
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Telephone | 516-205-2430
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. JOYCE OLUFUNKE ADEDUGBE
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Credential | NP
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Telephone | 516-205-2430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 304978
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License Number State | NY
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