Provider Demographics
NPI:1487909164
Name:NKEMTAJI, JONG A
Entity type:Individual
Prefix:
First Name:JONG
Middle Name:A
Last Name:NKEMTAJI
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 1:3823 64TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1876
Mailing Address - Country:US
Mailing Address - Phone:240-429-2582
Mailing Address - Fax:
Practice Address - Street 1:3823 64TH AVE APT 3
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1876
Practice Address - Country:US
Practice Address - Phone:240-429-2582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide