Provider Demographics
NPI:1659332708
Name:JACK, KELVIN KARIBO (MD)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:KARIBO
Last Name:JACK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3225 FENTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2801
Mailing Address - Country:US
Mailing Address - Phone:718-644-0961
Mailing Address - Fax:
Practice Address - Street 1:407 ROCKAWAY AVE FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5635
Practice Address - Country:US
Practice Address - Phone:718-644-0961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY272090207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1316289853OtherNPI