Provider Demographics
NPI:1437516069
Name:NISSI DIABETES CARE NP-ADULT HEALTH P.C.
Entity Type:Organization
Organization Name:NISSI DIABETES CARE NP-ADULT HEALTH P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:OLUFUNKE
Authorized Official - Last Name:ADEDUGBE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:516-205-2430
Mailing Address - Street 1:437 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1819
Mailing Address - Country:US
Mailing Address - Phone:516-205-2430
Mailing Address - Fax:
Practice Address - Street 1:437 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-1819
Practice Address - Country:US
Practice Address - Phone:516-205-2430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304978261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty