Basic Information
| Provider Information | |||||||||
| NPI: | 1376945253 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KRI KHEM MEDICAL, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 272 W 127TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100272910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9178363484 | ||||||||
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| Practice Location | |||||||||
| Address1: | 272 W 127TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100272910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9178363484 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2014 | ||||||||
| LastUpdateDate: | 10/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | NYAMEKYE | ||||||||
| AuthorizedOfficialFirstName: | ABSYLOM | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9178363484 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 208330 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.