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General NPI Number Information
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NPI Number | 1962683045
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Entity Type | Organization
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Legal Business Name | AGNES O
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Dates
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Enumeration Date | 11/17/2007
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Last Update Date | 11/17/2007
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Provider Practice Location Address
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Address Line | 3630 BECKER ST
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City | SCHENECTADY
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State | NY
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Zip | 12304-2424
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Country | US
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Telephone | 518-207-1507
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Fax |
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Provider Business Mailing Address
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Address Line | 3630 BECKER ST
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City | SCHENECTADYNY
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State | NY
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Zip | 12304-2424
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Country | US
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Telephone | 518-207-1507
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | AGNES SERWAH OBENG
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Credential |
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Telephone | 518-207-1501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 268485-1
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License Number State | NY
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