Basic Information
| Provider Information | |||||||||
| NPI: | 1912195579 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AGDINAOAY | ||||||||
| FirstName: | NOLY | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 821 THROGGS NECK EXPY | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104652320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187944117 | ||||||||
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| Practice Location | |||||||||
| Address1: | 339 HICKS ST | ||||||||
| Address2: | DEPT. OF EMERGENCY MEDICINE-LONG ISLAND COLLEGE HOSP | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112015509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187804764 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 10/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | F381687 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.