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General NPI Number Information
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NPI Number | 1336980945
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Entity Type | Organization
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Legal Business Name | KWEIBA MEDICAL PC
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 7143 SUTTON PL APT 3
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-4584
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Country | US
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Telephone | 917-617-1197
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Fax |
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Provider Business Mailing Address
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Address Line | 7529 PARSONS BLVD # 1018
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City | FRESH MEADOWS
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State | NY
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Zip | 11366-1037
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND PRESIDENT
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Name | BAABA BLANKSON
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Credential | MD
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Telephone | 937-617-1197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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