Provider Demographics
NPI:1417218991
Name:KMP MEDICAL PLLC
Entity type:Organization
Organization Name:KMP MEDICAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MAINARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-693-6988
Mailing Address - Street 1:49 MURRAY ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-2250
Mailing Address - Country:US
Mailing Address - Phone:212-729-1283
Mailing Address - Fax:
Practice Address - Street 1:49 MURRAY ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-2250
Practice Address - Country:US
Practice Address - Phone:212-729-1283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty