Jimoh David Afolabi, LPN
Individual provider Active NPI Licensed Practical Nurse · Elmont, NY
NPI 1780077263 · NPPES record last updated Mar 9, 2015
Key facts
- NPI
- 1780077263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 321500 (NY)
- Practice address
- 74 Caroline Ave
Elmont, NY 11003-5019 - Phone
- (516) 395-3674
- NPI assigned
- Mar 9, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NP07227600 | NJ | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 321500 | NY | Yes |
| Licensed Practical Nurse | 164W00000X | 26NP07227600 | NJ |
Addresses
Primary practice location
74 Caroline Ave
Elmont, NY 11003-5019
Mailing address
74 Caroline Ave
Elmont, NY 11003-5019
Phone (516) 395-3674
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All providers in Elmont, NY · Licensed Practical Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.