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General NPI Number Information
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NPI Number | 1124276282
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Entity Type | Individual
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Provider Name | KIMBERLY D. ZEDALIS
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Gender | Female
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 2780 MIDDLE COUNTRY RD STE 210
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City | LAKE GROVE
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State | NY
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Zip | 11755-2124
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Country | US
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Telephone | 631-588-4500
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Fax | 631-588-4595
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Provider Business Mailing Address
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Address Line | 2780 MIDDLE COUNTRY RD STE 210
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City | LAKE GROVE
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State | NY
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Zip | 11755-2124
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Country | US
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Telephone | 631-588-4500
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Fax | 631-588-4595
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | 956080
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2471M2300X
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Taxonomy Name | Mammography Radiologic Technologist
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License Number | 956080
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 243U00000X
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Taxonomy Name | Radiology Practitioner Assistant
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License Number | 000142
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License Number State | NY
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