Provider Demographics
NPI:1548584832
Name:KALIVOGUI, KEZELY
Entity Type:Individual
Prefix:
First Name:KEZELY
Middle Name:
Last Name:KALIVOGUI
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 1:1230 WOODYCREST AVE APT 5E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-3732
Mailing Address - Country:US
Mailing Address - Phone:917-319-8337
Mailing Address - Fax:
Practice Address - Street 1:1230 WOODYCREST AVE APT 5E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3732
Practice Address - Country:US
Practice Address - Phone:917-319-8337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY621561251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health