Healthcare Provider Details

I. General information

NPI: 1912096884
Provider Name (Legal Business Name): JUDE KWAME ARTHUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 GRAND CONCOURSE SUITE 1-C
BRONX NY
10451-2814
US

IV. Provider business mailing address

860 GRAND CONCOURSE SUITE 1-C
BRONX NY
10451-2814
US

V. Phone/Fax

Practice location:
  • Phone: 718-665-7384
  • Fax: 718-665-5335
Mailing address:
  • Phone: 718-665-7384
  • Fax: 718-665-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number201138
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: