Healthcare Provider Details

I. General information

NPI: 1346244704
Provider Name (Legal Business Name): KIMBERLY KAROL ELMER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date: 06/23/2005
Reactivation Date: 08/04/2005

III. Provider practice location address

532 MOE RD CLIFTON PARK
CLIFTON PARK NY
12065-3822
US

IV. Provider business mailing address

532 MOE RD CLIFTON PARK
CLIFTON PARK NY
12065-3822
US

V. Phone/Fax

Practice location:
  • Phone: 518-383-2425
  • Fax: 518-383-3255
Mailing address:
  • Phone: 518-383-2425
  • Fax: 518-383-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200045
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: