=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376945253
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KRI KHEM MEDICAL, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2014
-----------------------------------------------------
Last Update Date | 10/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 272 W 127TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10027-2910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-836-3484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 272 W 127TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10027-2910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-836-3484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. ABSYLOM K NYAMEKYE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 917-836-3484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 208330
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------