Provider Demographics
NPI:1831736594
Name:BOWERS, CHESLEY KADEEM II
Entity type:Individual
Prefix:
First Name:CHESLEY
Middle Name:KADEEM
Last Name:BOWERS
Suffix:II
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 1:34 W 139TH ST FRNT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1529
Mailing Address - Country:US
Mailing Address - Phone:212-690-7190
Mailing Address - Fax:
Practice Address - Street 1:34 W 139TH ST FRNT 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1529
Practice Address - Country:US
Practice Address - Phone:212-690-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJB68821227208922103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst