Provider Demographics
NPI:1346679420
Name:WAGGEH, BINTOU
Entity Type:Individual
Prefix:
First Name:BINTOU
Middle Name:
Last Name:WAGGEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 VALENTINE AVE APT 604
Mailing Address - Street 2:2000 VALENTINE AVE APT 604
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457
Mailing Address - Country:US
Mailing Address - Phone:347-337-6653
Mailing Address - Fax:
Practice Address - Street 1:2000 VALENTINE AVE APT 604
Practice Address - Street 2:2000 VALENTINE AVE APT 604
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:347-337-6653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316716164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse