Provider Demographics
NPI:1194588384
Name:WALKER, KAFELE HAMADI (CPT)
Entity type:Individual
Prefix:MR
First Name:KAFELE
Middle Name:HAMADI
Last Name:WALKER
Suffix:
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 NELSON AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-1773
Mailing Address - Country:US
Mailing Address - Phone:516-765-5020
Mailing Address - Fax:
Practice Address - Street 1:1525 NELSON AVE APT 3E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-1773
Practice Address - Country:US
Practice Address - Phone:516-765-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYG6A6Q3Q7246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYND68376JMedicaid