Provider Demographics
NPI:1427520816
Name:JAMMEH, YANKUBA
Entity type:Individual
Prefix:
First Name:YANKUBA
Middle Name:
Last Name:JAMMEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:163 BREWER RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1220
Mailing Address - Country:US
Mailing Address - Phone:646-290-1818
Mailing Address - Fax:
Practice Address - Street 1:163 BREWER RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1220
Practice Address - Country:US
Practice Address - Phone:646-290-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-22
Last Update Date:2018-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207PE0004X207PE0004X
NY146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services