Provider Demographics
NPI:1174936785
Name:THEODORE AKABUOGU
Entity type:Organization
Organization Name:THEODORE AKABUOGU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:U
Authorized Official - Last Name:AKABUOGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:017-500-5325
Mailing Address - Street 1:414 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7904
Mailing Address - Country:US
Mailing Address - Phone:017-500-5325
Mailing Address - Fax:
Practice Address - Street 1:414 E 31ST STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226
Practice Address - Country:US
Practice Address - Phone:917-500-5325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318578-1261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care