Provider Demographics
NPI:1528380888
Name:BADMUS, RAFEEU AYO
Entity Type:Individual
Prefix:
First Name:RAFEEU
Middle Name:AYO
Last Name:BADMUS
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 1:220-02 HEMPSTEAD AVE
Mailing Address - Street 2:APT 2R
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429
Mailing Address - Country:US
Mailing Address - Phone:646-427-6716
Mailing Address - Fax:
Practice Address - Street 1:220-02 HEMPSTEAD AVE
Practice Address - Street 2:APT 2R
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429
Practice Address - Country:US
Practice Address - Phone:646-427-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279366164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse