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General NPI Number Information
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NPI Number | 1295461036
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Entity Type | Organization
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Legal Business Name | KBS MEDICAL PA
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 3350 SW 148TH AVE STE 110
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City | MIRAMAR
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State | FL
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Zip | 33027-3237
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Country | US
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Telephone | 847-420-5269
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Fax |
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Provider Business Mailing Address
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Address Line | 169 MADISON AVE STE 15824
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City | NEW YORK
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State | NY
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Zip | 10016-5101
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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 | COO
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Name | LISA KENNEDY
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Credential |
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Telephone | 212-620-3053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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