Provider Demographics
NPI:1972154144
Name:KROMAH, FESTUS JR
Entity Type:Individual
Prefix:
First Name:FESTUS
Middle Name:
Last Name:KROMAH
Suffix:JR
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 1:193 JEFFERSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2959
Mailing Address - Country:US
Mailing Address - Phone:781-691-0441
Mailing Address - Fax:
Practice Address - Street 1:193 JEFFERSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2959
Practice Address - Country:US
Practice Address - Phone:781-691-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)