Healthcare Provider Details

I. General information

NPI: 1265207211
Provider Name (Legal Business Name): KIM ANN BREIHOF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 ROUTE 35 STE 6N-1
KATONAH NY
10536-3181
US

IV. Provider business mailing address

2875 ROUTE 35 STE 6N-1
KATONAH NY
10536-3181
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-0191
  • Fax:
Mailing address:
  • Phone: 914-666-0191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number416454
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: