Healthcare Provider Details

I. General information

NPI: 1881066983
Provider Name (Legal Business Name): KWB FIRSTWATCH MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 BROADWAY
BROOKLYN NY
11211-7308
US

IV. Provider business mailing address

1416 MADISON ST
ELMONT NY
11003-1308
US

V. Phone/Fax

Practice location:
  • Phone: 718-384-0010
  • Fax: 718-599-4632
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: KIVANJIT KAUR
Title or Position: OWNER
Credential:
Phone: 718-644-9410