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General NPI Number Information
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NPI Number | 1083998504
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Entity Type | Organization
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Legal Business Name | KIMATHI BODYWORK
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Dates
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Enumeration Date | 10/03/2011
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 1111 OCEAN AVE
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City | BROOKLYN
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State | NY
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Zip | 11230
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Country | US
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Telephone | 917-250-1507
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 OCEAN AVE
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City | BROOKLYN
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State | NY
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Zip | 11230
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/MT
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Name | KIMATHI CARD
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Credential |
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Telephone | 917-250-1507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0134291
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License Number State | NY
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