Healthcare Provider Details

I. General information

NPI: 1669803110
Provider Name (Legal Business Name): JOSEPH KASAMBA DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 MACON ST
BROOKLYN NY
11233-1008
US

IV. Provider business mailing address

PO BOX 1155
MONROE NY
10949-8155
US

V. Phone/Fax

Practice location:
  • Phone: 347-336-0582
  • Fax:
Mailing address:
  • Phone: 347-336-0582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number672861
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402638
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: