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General NPI Number Information
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NPI Number | 1740611631
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Entity Type | Individual
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Provider Name | MARY TOSSOUKPE
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Gender | Female
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 08/22/2017
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Provider Practice Location Address
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Address Line | 1708 FRANCIS LEWIS BLVD
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City | WHITESTONE
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State | NY
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Zip | 11357-3247
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Country | US
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Telephone | 973-422-1433
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Fax |
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Provider Business Mailing Address
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Address Line | 600 E 137TH ST APT 2A
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City | BRONX
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State | NY
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Zip | 10454-3114
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Country | US
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Telephone | 646-724-9079
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | 317122
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 317122
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License Number State | NY
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