Healthcare Provider Details

I. General information

NPI: 1508076191
Provider Name (Legal Business Name): KIMBERLY SILVERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 CLIFF STREET
ITHACA NY
14850-0000
US

IV. Provider business mailing address

202 TAUGHANNOCK BLVD. PO BOX 366
ITHACA NY
14851-0000
US

V. Phone/Fax

Practice location:
  • Phone: 607-277-4035
  • Fax:
Mailing address:
  • Phone: 607-277-4035
  • Fax: 607-277-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number220803
License Number StateNY

VIII. Authorized Official

Name: DR. KIMBERLY J SILVERS
Title or Position: OWNER
Credential: MD
Phone: 607-277-4035