Individual ProviderAnike Alice EgbetokumLicensed Practical NurseNursing Service ProvidersPractice Address38 Rider Ave, Apt 521, Patchogue, NY 11772-3900(631) 295-7865PECOS EnrollmentBased on the most recent information from CMS, provider Anike Alice Egbetokum does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1962739243Provider TypeIndividualFull NameEgbetokum, Anike AliceTitleMs.CredentialLPNGenderFemaleSole ProprietorYesEnumeration Date11/8/2009Last Updated11/8/2009Contact InformationPractice LocationPractice Address38 Rider Ave, Apt 521, Patchogue, NY 11772-3900Phone(631) 295-7865FaxUnlisted FaxMailing LocationMailing Address38 Rider Ave, Apt 521, Patchogue, NY 11772-3900Phone(631) 295-7865FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense299117-1New York