Provider Demographics
NPI:1417539586
Name:NGUM, ABDOULIE
Entity Type:Individual
Prefix:
First Name:ABDOULIE
Middle Name:
Last Name:NGUM
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 1:1070 HAVEMEYER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5310
Mailing Address - Country:US
Mailing Address - Phone:718-863-6200
Mailing Address - Fax:914-530-2161
Practice Address - Street 1:1070 HAVEMEYER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5310
Practice Address - Country:US
Practice Address - Phone:718-863-6200
Practice Address - Fax:914-530-2161
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314392164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse