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General NPI Number Information
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NPI Number | 1538059571
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Entity Type | Individual
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Provider Name | KYLE COBB
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Gender | Male
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 1745 UNION BLVD
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City | BAY SHORE
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State | NY
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Zip | 11706-7952
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Country | US
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Telephone | 631-323-4255
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Fax |
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Provider Business Mailing Address
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Address Line | 90 WOODSOME RD
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City | BABYLON
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State | NY
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Zip | 11702-3318
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Country | US
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Telephone | 631-495-0085
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 312351
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License Number State | NY
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