Healthcare Provider Details

I. General information

NPI: 1043147598
Provider Name (Legal Business Name): KESIA KUNJUMON DANIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 MAIN STREET
FLUSHING NY
11355
US

IV. Provider business mailing address

1808 ATHERTON AVE
ELMONT NY
11003-1720
US

V. Phone/Fax

Practice location:
  • Phone: 929-422-3880
  • Fax: 718-732-1307
Mailing address:
  • Phone: 917-602-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP141785
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: