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General NPI Number Information
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NPI Number | 1689027112
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Entity Type | Individual
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Provider Name | KIMBERLY MIEBACH
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Gender | Female
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 192 TOWER DR SUITE 400
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City | MIDDLETOWN
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State | NY
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Zip | 10941-2056
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Country | US
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Telephone | 845-692-4391
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Fax |
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Provider Business Mailing Address
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Address Line | 156 RT 15 NORTH
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City | LAFFAYETTE
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State | NJ
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Zip | 07848
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Country | US
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Telephone | 973-862-6377
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 41YS00961300
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License Number State | NJ
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