Healthcare Provider Details

I. General information

NPI: 1205813680
Provider Name (Legal Business Name): KIMBERLY B PRISE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 TRANSIT RD
LANCASTER NY
14043-4888
US

IV. Provider business mailing address

4711 TRANSIT RD
LANCASTER NY
14043-4888
US

V. Phone/Fax

Practice location:
  • Phone: 716-668-5331
  • Fax: 716-668-5370
Mailing address:
  • Phone: 716-668-5331
  • Fax: 716-668-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number209492
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: