Basic Information
Provider Information | |||||||||
NPI: | 1508083700 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KARGBO | ||||||||
FirstName: | ESTHER | ||||||||
MiddleName: | COMFORT | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | NONE | ||||||||
OtherFirstName: | NONE | ||||||||
OtherMiddleName: | NONE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | NONE | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 123 KINGSWOOD RD | ||||||||
Address2: |   | ||||||||
City: | NEWARK | ||||||||
State: | DE | ||||||||
PostalCode: | 197133054 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3024561056 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2250 HICKORY RD STE 240 | ||||||||
Address2: |   | ||||||||
City: | PLYMOUTH MEETING | ||||||||
State: | PA | ||||||||
PostalCode: | 194622225 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6108341122 | ||||||||
FaxNumber: | 6108347525 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/19/2007 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 376K00000X | NA000000702171 | DE | Y |   | Nursing Service Related Providers | Nurse's Aide |   |
No ID Information.