Provider Demographics
NPI:1952310666
Name:A'BODJEDI, ENENGE (MD)
Entity Type:Individual
Prefix:
First Name:ENENGE
Middle Name:
Last Name:A'BODJEDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE HOSPITAL PLAZA
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06904-9317
Mailing Address - Country:US
Mailing Address - Phone:203-276-7111
Mailing Address - Fax:203-276-7081
Practice Address - Street 1:ONE HOSPITAL PLAZA
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06904-9317
Practice Address - Country:US
Practice Address - Phone:203-276-7111
Practice Address - Fax:203-276-7081
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0396472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP00317095OtherRAILROAD MEDICARE
CT110009761Medicare ID - Type Unspecified
CT001396474OtherBLUECARE MEDICAID
H44440Medicare UPIN