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NPI Code Detail

MEDICARE: MR. DESPEE BOCKARIE KONNEH PA-C

MEDICARE: MR. DESPEE BOCKARIE KONNEH PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant25MP00493300NJ

General Provider Information

NPI Number : 1417955279
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DESPEE BOCKARIE KONNEH PA-C
Provider Business Mailing Address
First Line : 30 PROSPECT AVE
Second Line :
City : HACKENSACK
State : NJ
Zip : 07601-1915
Country : US
Telephone Number : 551-996-2000
Fax Number :
Provider Business Practice Location Address
First Line : 30 PROSPECT AVE
Second Line :
City : HACKENSACK
State : NJ
Zip : 07601-1915
Country : US
Telephone Number : 551-996-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 11/02/2018

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