Basic Information
| Provider Information | |||||||||
| NPI: | 1003292988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMASOGUNDEINDE | ||||||||
| FirstName: | ABOSEDE | ||||||||
| MiddleName: | ADETOUN | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 N CORONA AVE | ||||||||
| Address2: | |||||||||
| City: | VALLEY STREAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115802602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184099322 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 303 MAIN ST | ||||||||
| Address2: | APT 241 | ||||||||
| City: | HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115501427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184099322 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2015 | ||||||||
| LastUpdateDate: | 10/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 315975 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.