Provider Demographics
NPI:1891053260
Name:ASUBONTENG, EMMAUNUEL A (LPN)
Entity Type:Individual
Prefix:MR
First Name:EMMAUNUEL
Middle Name:A
Last Name:ASUBONTENG
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 AVENUE J
Mailing Address - Street 2:APT. 3E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4344
Mailing Address - Country:US
Mailing Address - Phone:347-225-7953
Mailing Address - Fax:
Practice Address - Street 1:3602 AVENUE J
Practice Address - Street 2:APT. 3E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4344
Practice Address - Country:US
Practice Address - Phone:347-225-7953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308700-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse