Provider Demographics
NPI:1861149924
Name:ASSOMOU, BLANDINE
Entity type:Individual
Prefix:
First Name:BLANDINE
Middle Name:
Last Name:ASSOMOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10818 QUEENS BLVD STE 4A5TH
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4748
Mailing Address - Country:US
Mailing Address - Phone:212-804-7659
Mailing Address - Fax:888-975-7704
Practice Address - Street 1:10818 QUEENS BLVD STE 4A5TH
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4748
Practice Address - Country:US
Practice Address - Phone:212-804-7659
Practice Address - Fax:888-975-7704
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator