Provider Demographics
NPI:1992041875
Name:AJAVON, MAJAMBU
Entity Type:Individual
Prefix:
First Name:MAJAMBU
Middle Name:
Last Name:AJAVON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 HERBERT AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1223
Mailing Address - Country:US
Mailing Address - Phone:516-270-3128
Mailing Address - Fax:
Practice Address - Street 1:153 HERBERT AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1223
Practice Address - Country:US
Practice Address - Phone:516-270-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310804164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse