Provider Demographics
NPI:1801161278
Name:GOBADAN, SOMARIA (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:SOMARIA
Middle Name:
Last Name:GOBADAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BAYCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1756
Mailing Address - Country:US
Mailing Address - Phone:718-904-5650
Mailing Address - Fax:718-904-5655
Practice Address - Street 1:700 BAYCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1756
Practice Address - Country:US
Practice Address - Phone:718-904-5650
Practice Address - Fax:718-904-5655
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-18
Last Update Date:2012-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY468687-1163W00000X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY468687-1OtherREGISTERED NURSE
NY0420022OtherREGISTERED NURSE
NY0420022OtherNURSE