Healthcare Provider Details

I. General information

NPI: 1225409055
Provider Name (Legal Business Name): MR. KEVIN HAMILTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 E 57TH ST
BROOKLYN NY
11203-5425
US

IV. Provider business mailing address

427 E 57TH ST
BROOKLYN NY
11203-5425
US

V. Phone/Fax

Practice location:
  • Phone: 347-201-3560
  • Fax: 347-851-8923
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95030216
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number648473
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402467
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: