Healthcare Provider Details

I. General information

NPI: 1417069352
Provider Name (Legal Business Name): DR. KINA COULANGES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LINDEN BLVD.
BROOKLYN NY
11212
US

IV. Provider business mailing address

80 MARCUS DRIVE
MELVILLE NY
11747
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-5071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number227166
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: