Nneka Agum, MD
Individual provider Active NPI Family Medicine Physician · New York, NY
NPI 1831776533 · NPPES record last updated Jun 9, 2026
Key facts
- NPI
- 1831776533
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 339457 (NY)
- Practice address
- 2702 Broadway
New York, NY 10025-8701 - Phone
- (212) 304-7070
- Fax
- (212) 304-7080
- NPI assigned
- Mar 27, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2018
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
400 Kelby St
FL 9
Fort Lee, NJ 07024-2939
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260624000458 | NY | Practitioner - Family Practice | 1456759745 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T-4274 | MS | MD | Family Medicine Physician |
Interoperability endpoints
- nneka.agum.1@20428.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 339457 | NY | |
| Family Medicine Physician | 207Q00000X | 339457 | NY | Yes |
Addresses
Primary practice location
2702 Broadway
New York, NY 10025-8701
Mailing address
2702 Broadway
New York, NY 10025-8701
Phone (212) 304-7070
Other practice location 1
1 Gustave L Levy Pl # 1070
New York, NY 10029-6504
Phone (212) 241-6500
Other providers in New York, NY
- Luzelenia Aguirre
- Paul David Aguirre
- Ruby Aguirre
- Jillian Aguis
- Nicholas Agulnick
- Ariel Agur
- Agus Family Corp
- Elmer C Agustin
- Ninia Eliza Agustin
- Alison Agvent
All providers in New York, NY · Family Medicine Physician 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 Jun 9, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.