Provider Demographics
NPI:1972169464
Name:TAMFU, MARTIN AHIDJO
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:AHIDJO
Last Name:TAMFU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 S FULTON AVE APT 20B
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1438
Mailing Address - Country:US
Mailing Address - Phone:347-849-9815
Mailing Address - Fax:
Practice Address - Street 1:300 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1810
Practice Address - Country:US
Practice Address - Phone:914-345-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106367-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker