Provider Demographics
NPI:1699473306
Name:ANKOMA, KWAME K
Entity type:Individual
Prefix:MR
First Name:KWAME
Middle Name:K
Last Name:ANKOMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ALDRICH ST APT 16D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4510
Mailing Address - Country:US
Mailing Address - Phone:917-432-4634
Mailing Address - Fax:
Practice Address - Street 1:120 ALDRICH ST APT 16D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4510
Practice Address - Country:US
Practice Address - Phone:917-432-4634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY404776363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health