Provider Demographics
NPI:1790084507
Name:AGBOOLA, ABIOLA A (RN CNM)
Entity Type:Individual
Prefix:
First Name:ABIOLA
Middle Name:A
Last Name:AGBOOLA
Suffix:
Gender:F
Credentials:RN CNM
Other - Prefix:
Other - First Name:ABIOLA
Other - Middle Name:A
Other - Last Name:AGBOOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:194 TARGEE ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1926
Mailing Address - Country:US
Mailing Address - Phone:347-276-1280
Mailing Address - Fax:718-390-5166
Practice Address - Street 1:194 TARGEE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1926
Practice Address - Country:US
Practice Address - Phone:347-276-1280
Practice Address - Fax:718-390-5166
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1343L0011041C0700X, 133N00000X, 225100000X, 225X00000X, 364SH0200X, 3747P1801X, 207ZC0006X
NY403674163W00000X, 163WH0200X, 163WX0002X
NY360383163WA2000X
NYF000731176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
No176B00000XOther Service ProvidersMidwife
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant