Healthcare Provider Details

I. General information

NPI: 1255143236
Provider Name (Legal Business Name): KIMBERLY ARCILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2025
Last Update Date: 01/25/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FORT WASHINGTON AVE
NEW YORK NY
10032-3729
US

IV. Provider business mailing address

60 E LINDEN AVE APT 3C
ENGLEWOOD NJ
07631-3650
US

V. Phone/Fax

Practice location:
  • Phone: 877-426-5637
  • Fax:
Mailing address:
  • Phone: 914-217-5795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF353520-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: