Provider Demographics
NPI:1386811479
Name:CHARLES P KIMMELMAN MD FACS PC
Entity type:Organization
Organization Name:CHARLES P KIMMELMAN MD FACS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KIMMELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-717-7262
Mailing Address - Street 1:993 PARK AVE
Mailing Address - Street 2:STE C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0809
Mailing Address - Country:US
Mailing Address - Phone:212-717-7262
Mailing Address - Fax:212-717-1307
Practice Address - Street 1:993 PARK AVE
Practice Address - Street 2:STE C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0809
Practice Address - Country:US
Practice Address - Phone:212-717-7262
Practice Address - Fax:212-717-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY165440OtherNYS LICENSE
NYWYTXP1OtherORGANIZATIONAL PTAN
NYWYTXP1OtherORGANIZATIONAL PTAN
NY165440OtherNYS LICENSE