Provider Demographics
NPI:1841085008
Name:MEME, KENSKY (NP)
Entity type:Individual
Prefix:
First Name:KENSKY
Middle Name:
Last Name:MEME
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21814 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-1209
Mailing Address - Country:US
Mailing Address - Phone:917-607-8877
Mailing Address - Fax:
Practice Address - Street 1:1122 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1025
Practice Address - Country:US
Practice Address - Phone:718-377-2834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311819363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health