Provider Demographics
NPI:1407060106
Name:KIWALA, LOUIS (PA-C, AP,LAC,DNBAO)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:KIWALA
Suffix:
Gender:M
Credentials:PA-C, AP,LAC,DNBAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 BROADWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1831
Mailing Address - Country:US
Mailing Address - Phone:646-596-7386
Mailing Address - Fax:646-360-2739
Practice Address - Street 1:157 REMSEN STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4321
Practice Address - Country:US
Practice Address - Phone:718-260-1000
Practice Address - Fax:718-260-0072
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000765171100000X
FLAP 1958171100000X
NY014653363A00000X
NJ25MP00264900363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171100000XOther Service ProvidersAcupuncturist
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13-391-4210Medicare UPIN