Provider Demographics
NPI:1528747508
Name:TAYLOR, KIMBERLY M
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10115 157TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2848
Mailing Address - Country:US
Mailing Address - Phone:347-495-0540
Mailing Address - Fax:
Practice Address - Street 1:10115 157TH AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2848
Practice Address - Country:US
Practice Address - Phone:347-495-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist