MEDICARE: MRS. KIMBERLY POEPPLEIN RN, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	717410	NY
2	174400000X	Specialist	001329-1	NY

General Provider Information

NPI Number	:	1093817678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY POEPPLEIN RN, ATC

Provider Business Mailing Address
First Line	:	439 N BLEECKER DR
Second Line	:
City	:	NORTH MASSAPEQUA
State	:	NY
Zip	:	11758-1334
Country	:	US
Telephone Number	:	516-784-8466
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 STEWART AVE
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-4892
Country	:	US
Telephone Number	:	516-227-5344
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	04/11/2024

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