Healthcare Provider Details

I. General information

NPI: 1275093379
Provider Name (Legal Business Name): KIMBERLY LAUGHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 BROADWAY RM 304
NEW YORK NY
10012-3271
US

IV. Provider business mailing address

PO BOX 81063
CLEVELAND OH
44181-0063
US

V. Phone/Fax

Practice location:
  • Phone: 212-966-7600
  • Fax:
Mailing address:
  • Phone: 561-322-4171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number341772
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: