MEDICARE: KESTER IAN ANGELES NURSE PRACTITIONER

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	363LP2300X	Primary Care Nurse Practitioner	360084	NY

General Provider Information

NPI Number	:	1578496287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KESTER IAN ANGELES NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	406 W 44TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-5206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	406 W 44TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-5206
Country	:	US
Telephone Number	:	917-292-4428
Fax Number	:

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

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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