Healthcare Provider Details

I. General information

NPI: 1952355182
Provider Name (Legal Business Name): KIMBERLY D KINNEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 RAMLAND RD S STE 200A
ORANGEBURG NY
10962-2626
US

IV. Provider business mailing address

704 PALISADE AVE
TEANECK NJ
07666-3144
US

V. Phone/Fax

Practice location:
  • Phone: 845-359-0010
  • Fax: 845-359-3414
Mailing address:
  • Phone: 201-836-4301
  • Fax: 201-530-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA05827800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number183385
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: