Provider Demographics
NPI:1063078517
Name:KWAKYE, BENJAMIN KWAME (FNP)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:KWAME
Last Name:KWAKYE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 SEAGIRT BLVD APT 4E
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2827
Mailing Address - Country:US
Mailing Address - Phone:917-562-0817
Mailing Address - Fax:
Practice Address - Street 1:1786 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4203
Practice Address - Country:US
Practice Address - Phone:929-333-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344229-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily