Healthcare Provider Details

I. General information

NPI: 1891689048
Provider Name (Legal Business Name): KIMBERLY F GAROFALO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 INTREPID LN
SYRACUSE NY
13205-2544
US

IV. Provider business mailing address

5110 ONONDAGA RD
SYRACUSE NY
13215-1406
US

V. Phone/Fax

Practice location:
  • Phone: 315-469-8700
  • Fax: 315-469-6789
Mailing address:
  • Phone: 315-263-5804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number356945
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: