Individual
GUILLAUME GBOHO SIOGOUNI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1416 BROOKLYN AVE APT 4G, BROOKLYN, NY 11210-1869
(718) 284-5574
Mailing address
1416 BROOKLYN AVE APT 4G, BROOKLYN, NY 11210-1869
(401) 617-6761
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
671455
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112233
—
NY
Enumeration date
02/06/2014
Last updated
02/06/2014
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