Provider Demographics
NPI:1336980945
Name:KWEIBA MEDICAL PC
Entity type:Organization
Organization Name:KWEIBA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BAABA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-617-1197
Mailing Address - Street 1:7529 PARSONS BLVD # 1018
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7143 SUTTON PL APT 3
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-4584
Practice Address - Country:US
Practice Address - Phone:917-617-1197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPRING FORTH MEDICAL P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty