Provider Demographics
NPI:1700470796
Name:ENJECK, COMFORT MBAH
Entity Type:Individual
Prefix:
First Name:COMFORT
Middle Name:MBAH
Last Name:ENJECK
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 1:7611 RIVERDALE RD APT 314
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3750
Mailing Address - Country:US
Mailing Address - Phone:301-793-5844
Mailing Address - Fax:
Practice Address - Street 1:7611 RIVERDALE RD APT 314
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3750
Practice Address - Country:US
Practice Address - Phone:301-793-5844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCNA20210441Medicaid