Healthcare Provider Details

I. General information

NPI: 1306764030
Provider Name (Legal Business Name): WONDWOSEN KASSA ALEMAYEHU RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 GRAND CONCOURSE APT 3H
BRONX NY
10468-1235
US

IV. Provider business mailing address

3155 GRAND CONCOURSE APT 3H
BRONX NY
10468-1235
US

V. Phone/Fax

Practice location:
  • Phone: 646-225-0399
  • Fax:
Mailing address:
  • Phone: 646-225-0399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number008823-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: