Provider Demographics
NPI:1740611631
Name:TOSSOUKPE, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TOSSOUKPE
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 1:600 E 137TH ST
Mailing Address - Street 2:APT 2A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-3114
Mailing Address - Country:US
Mailing Address - Phone:646-724-9079
Mailing Address - Fax:
Practice Address - Street 1:1708 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3247
Practice Address - Country:US
Practice Address - Phone:973-422-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317122376G00000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No376G00000XNursing Service Related ProvidersNursing Home Administrator