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General NPI Number Information
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NPI Number | 1598637738
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Entity Type | Organization
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Legal Business Name | DOCTOR K PRIVATE MEDICINE PLLC
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Dates
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Enumeration Date | 09/18/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 426 W 14TH ST FL 3
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City | NEW YORK
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State | NY
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Zip | 10014-1002
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Country | US
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Telephone | 646-568-6636
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Fax |
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Provider Business Mailing Address
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Address Line | 426 W 14TH ST FL 3
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City | NEW YORK
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State | NY
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Zip | 10014-1002
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Country | US
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Telephone | 646-568-6636
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Fax |
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Authorized Official
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Title or Position | FOUNDER/OWNER
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Name | DR. ANDREW RUSSO KIBERT
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Credential | MD
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Telephone | 713-628-6126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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