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NPI Code Detail

MEDICARE: BENJAMIN KWAME KWAKYE FNP

MEDICARE: BENJAMIN KWAME KWAKYE FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerF344229-1NY

General Provider Information

NPI Number : 1063078517
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN KWAME KWAKYE FNP
Provider Business Mailing Address
First Line : 2012 SEAGIRT BLVD APT 4E
Second Line :
City : FAR ROCKAWAY
State : NY
Zip : 11691-2827
Country : US
Telephone Number : 917-562-0817
Fax Number :
Provider Business Practice Location Address
First Line : 1786 FLATBUSH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11210-4203
Country : US
Telephone Number : 929-333-9955
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2019
Last Update Date : 05/10/2019

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