Provider Demographics
NPI:1184038085
Name:HOUSE CALL NURSE PRACTITIONER IN ADULT HEALTH, PLLC
Entity Type:Organization
Organization Name:HOUSE CALL NURSE PRACTITIONER IN ADULT HEALTH, PLLC
Other - Org Name:CARE ACCESS ADULT HEALTH NP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADULT NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ADEBUKOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADENIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:631-482-9880
Mailing Address - Street 1:133 E MAIN ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3517
Mailing Address - Country:US
Mailing Address - Phone:631-482-9880
Mailing Address - Fax:631-482-9911
Practice Address - Street 1:133 E MAIN ST STE 1B
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3517
Practice Address - Country:US
Practice Address - Phone:631-482-9880
Practice Address - Fax:631-482-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04042577Medicaid