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General NPI Number Information
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NPI Number | 1700464880
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Entity Type | Individual
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Provider Name | NICOLE KIESS DO
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Gender | Female
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 52 W 8TH ST
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City | NEW YORK
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State | NY
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Zip | 10011-9092
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Country | US
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Telephone | 212-466-4848
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Fax |
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Provider Business Mailing Address
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Address Line | 52 W 8TH ST
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City | NEW YORK
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State | NY
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Zip | 10011-9092
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Country | US
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Telephone | 212-466-4848
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 335531
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License Number State | NY
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