Provider Demographics
NPI:1275812224
Name:CYRIL EFUETENJOK, NGUTI (LPN)
Entity Type:Individual
Prefix:
First Name:NGUTI
Middle Name:
Last Name:CYRIL EFUETENJOK
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3520
Mailing Address - Country:US
Mailing Address - Phone:914-997-0420
Mailing Address - Fax:
Practice Address - Street 1:777 WESTCHESTER AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3520
Practice Address - Country:US
Practice Address - Phone:914-997-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY701397163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY297888OtherLICENSED PRACTICAL NURSE