Provider Demographics
NPI:1891235412
Name:KOUDEDJA DEMBELE
Entity Type:Organization
Organization Name:KOUDEDJA DEMBELE
Other - Org Name:SAPPHIRE CENTER FOR REHABILITATION
Other - Org Type:Other Name
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MS
Authorized Official - First Name:KOUDEDJA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMBELE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:914-500-5929
Mailing Address - Street 1:16 LOCUST AVE # IH
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-7331
Mailing Address - Country:US
Mailing Address - Phone:914-500-5929
Mailing Address - Fax:
Practice Address - Street 1:16 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-7331
Practice Address - Country:US
Practice Address - Phone:914-500-5929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338512-1282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access