Provider Demographics
NPI:1013345842
Name:FOLLIKOUE, EKOUE
Entity Type:Individual
Prefix:
First Name:EKOUE
Middle Name:
Last Name:FOLLIKOUE
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 1:357 E 150TH ST
Mailing Address - Street 2:3E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-2700
Mailing Address - Country:US
Mailing Address - Phone:917-891-5579
Mailing Address - Fax:
Practice Address - Street 1:357 E 150TH ST
Practice Address - Street 2:3E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-2700
Practice Address - Country:US
Practice Address - Phone:917-891-5579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316531-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse