MEDICARE: DR. DAVID H. KINGSLEY PHD

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	174400000X	Specialist		NY

General Provider Information

NPI Number	:	1366640062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID H. KINGSLEY PHD

Provider Business Mailing Address
First Line	:	100 WHEELER AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4018
Country	:	US
Telephone Number	:	718-980-4700
Fax Number	:	718-370-3745

Provider Business Practice Location Address
First Line	:	100 WHEELER AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4018
Country	:	US
Telephone Number	:	718-980-4700
Fax Number	:	718-370-3745

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

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	07/08/2007

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