Provider Demographics
NPI:1467597369
Name:NTIAMOAH, KWABENA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:KWABENA
Middle Name:
Last Name:NTIAMOAH
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Other - Last Name:
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Mailing Address - Street 1:3924 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2422
Mailing Address - Country:US
Mailing Address - Phone:718-466-6020
Mailing Address - Fax:178-466-6060
Practice Address - Street 1:1276 FULTON AVE. BRONX LEBANON HOSPITAL
Practice Address - Street 2:DEPT. OF PSYCHIATRY, 1276 FULTON AVE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:718-466-6020
Practice Address - Fax:718-466-6060
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY5300378363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical