MEDICARE: KWAME FOSU

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
1	164W00000X	Licensed Practical Nurse	293192-1	NY

General Provider Information

NPI Number	:	1457674053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KWAME FOSU

Provider Business Mailing Address
First Line	:	1166 GRAND CONCOURSE
Second Line	:	#23E
City	:	BRONX
State	:	NY
Zip	:	10456-3914
Country	:	US
Telephone Number	:	646-319-6383
Fax Number	:

Provider Business Practice Location Address
First Line	:	1166 GRAND CONCOURSE
Second Line	:	#23E
City	:	BRONX
State	:	NY
Zip	:	10456-3914
Country	:	US
Telephone Number	:	646-319-6383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2010
Last Update Date	:	03/10/2010

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Directions to “ KWAME FOSU ” Practice Location

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