Basic Information
| Provider Information | |||||||||
| NPI: | 1184269912 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEANS | ||||||||
| FirstName: | KAMEKA | ||||||||
| MiddleName: | ALECIA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 E 233RD ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104662604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189209838 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 E 210TH ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104672401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189202869 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2019 | ||||||||
| LastUpdateDate: | 11/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 024405 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 024405 | 05 | NY | MEDICAID |