Healthcare Provider Details

I. General information

NPI: 1952591380
Provider Name (Legal Business Name): GEORGINA KATHRYN KAMIDE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 GREGORY WAY
CALVERTON NY
11933
US

IV. Provider business mailing address

403 BROWNS ROAD
NESCONSET NY
11767
US

V. Phone/Fax

Practice location:
  • Phone: 631-929-0009
  • Fax:
Mailing address:
  • Phone: 631-849-2243
  • Fax: 631-849-2243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number385603 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: