Provider Demographics
NPI:1134487184
Name:NGOTEMBONG, SIMON K
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:K
Last Name:NGOTEMBONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5902 31ST AVE
Mailing Address - Street 2:APT 515
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2947
Mailing Address - Country:US
Mailing Address - Phone:240-640-4047
Mailing Address - Fax:
Practice Address - Street 1:5902 31ST AVE
Practice Address - Street 2:APT 515
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2947
Practice Address - Country:US
Practice Address - Phone:240-640-4047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide