Provider Demographics
NPI:1710487368
Name:SANNOH, ABU
Entity type:Individual
Prefix:
First Name:ABU
Middle Name:
Last Name:SANNOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 FOREST EDGE
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2947
Mailing Address - Country:US
Mailing Address - Phone:856-537-4684
Mailing Address - Fax:856-762-2876
Practice Address - Street 1:1605 E EVESHAM RD STE 100B
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1437
Practice Address - Country:US
Practice Address - Phone:856-355-7118
Practice Address - Fax:856-355-7116
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053250001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty