Provider Demographics
NPI:1912195579
Name:AGDINAOAY, NOLY G (CPNP)
Entity Type:Individual
Prefix:MR
First Name:NOLY
Middle Name:G
Last Name:AGDINAOAY
Suffix:
Gender:M
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 THROGGS NECK EXPY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2320
Mailing Address - Country:US
Mailing Address - Phone:718-794-4117
Mailing Address - Fax:
Practice Address - Street 1:339 HICKS ST
Practice Address - Street 2:DEPT. OF EMERGENCY MEDICINE-LONG ISLAND COLLEGE HOSP
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5509
Practice Address - Country:US
Practice Address - Phone:718-780-4764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381687363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics