Provider Demographics
NPI:1003069089
Name:KAMDEM, JEAN PIERRE
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:PIERRE
Last Name:KAMDEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 LENOX AVE
Mailing Address - Street 2:APT 14-C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1033
Mailing Address - Country:US
Mailing Address - Phone:917-291-7665
Mailing Address - Fax:
Practice Address - Street 1:650 LENOX AVE
Practice Address - Street 2:APT 14-C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1033
Practice Address - Country:US
Practice Address - Phone:718-671-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY610574-01163W00000X
NY293622164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse