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NPI Code Detail

MEDICARE: KYLE SMALL

MEDICARE: KYLE SMALL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker

General Provider Information

NPI Number : 1275817603
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE SMALL
Provider Business Mailing Address
First Line : 2795 RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-5866
Country : US
Telephone Number : 718-982-6982
Fax Number : 718-982-6916
Provider Business Practice Location Address
First Line : 2795 RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-5866
Country : US
Telephone Number : 718-982-6982
Fax Number : 718-982-6916
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2011
Last Update Date : 10/04/2011

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Directions to “ KYLE SMALL ” Practice Location

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