Provider Demographics
NPI:1710582879
Name:ALEMNJI, NTONGWAH DERRICK
Entity Type:Individual
Prefix:
First Name:NTONGWAH
Middle Name:DERRICK
Last Name:ALEMNJI
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 1:6200 SPRINGHILL DR APT 302
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1360
Mailing Address - Country:US
Mailing Address - Phone:202-845-2551
Mailing Address - Fax:
Practice Address - Street 1:6200 SPRINGHILL DR APT 302
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1360
Practice Address - Country:US
Practice Address - Phone:202-845-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA15343374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA15343Medicaid