Provider Demographics
NPI:1912369760
Name:KWASI-WULI, ENYONAM
Entity Type:Individual
Prefix:
First Name:ENYONAM
Middle Name:
Last Name:KWASI-WULI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ALCOTT PL
Mailing Address - Street 2:APT. 20 B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4102
Mailing Address - Country:US
Mailing Address - Phone:347-495-4228
Mailing Address - Fax:
Practice Address - Street 1:100 ALCOTT PL
Practice Address - Street 2:APT. 20 B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4102
Practice Address - Country:US
Practice Address - Phone:347-495-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor