Healthcare Provider Details

I. General information

NPI: 1508348459
Provider Name (Legal Business Name): KIMBERLY CHRISTINE SOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY CHRISTINE STANFORD

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E POST RD
WHITE PLAINS NY
10601-4699
US

IV. Provider business mailing address

47 LAKE JUST IT RD
GREAT MEADOWS NJ
07838-2418
US

V. Phone/Fax

Practice location:
  • Phone: 908-914-6849
  • Fax:
Mailing address:
  • Phone: 908-914-6849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: