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Individual

KENRICK WAITHE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1591 FULTON AVE, BRONX, NY 10457-8234
(718) 901-6470
(718) 716-4780
Mailing address
21 ELLWOOD AVE, MOUNT VERNON, NY 10552-3403
(718) 901-6471
(718) 716-4780

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
221526
NY

Other

Enumeration date
10/13/2006
Last updated
07/08/2007
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