Healthcare Provider Details

I. General information

NPI: 1386811479
Provider Name (Legal Business Name): CHARLES P KIMMELMAN MD FACS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 PARK AVE STE C
NEW YORK NY
10028-0809
US

IV. Provider business mailing address

993 PARK AVE STE C
NEW YORK NY
10028-0809
US

V. Phone/Fax

Practice location:
  • Phone: 212-717-7262
  • Fax: 212-717-1307
Mailing address:
  • Phone: 212-717-7262
  • Fax: 212-717-1307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES PAUL KIMMELMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 212-717-7262