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NPI Code Detail

MEDICARE: KIMBERLY D THOMAS

MEDICARE: KIMBERLY D THOMAS
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
1106S00000XBehavior TechnicianRBT-19-93279NY

General Provider Information

NPI Number : 1134882053
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY D THOMAS
Provider Business Mailing Address
First Line : 9520 222ND ST APT 5G
Second Line :
City : QUEENS VILLAGE
State : NY
Zip : 11429-1304
Country : US
Telephone Number : 347-886-5035
Fax Number :
Provider Business Practice Location Address
First Line : 1887 RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-3939
Country : US
Telephone Number : 718-698-1300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2021
Last Update Date : 10/18/2021

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Directions to “ KIMBERLY D THOMAS ” Practice Location

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