Active NPI
Mankazon Tidoe
- Licensed Practical Nurse
- Teaneck, NJ
National Provider Identifier
1184968471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 311887-1
- Practice address
- 14 Galway PL
Teaneck, NJ 07666-3631 - Phone
- (201) 837-9273
- NPI assigned
- Nov 27, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 311887-1 | NY | Primary |
Addresses
Primary practice location
14 Galway PL
Teaneck, NJ 07666-3631
Mailing address
14 Galway PL
Teaneck, NJ 07666-3631
Phone (201) 837-9273
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 311887-1 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353974400000",
"number": "1184968471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 GALWAY PL",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076663631",
"telephone_number": "201-837-9273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14 GALWAY PL",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076663631",
"telephone_number": "201-837-9273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIDOE",
"first_name": "MANKAZON",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-11-27",
"last_updated": "2012-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "311887-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Teaneck, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.