MEDICARE: KIMBERLY QUEZADA

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

General Provider Information

NPI Number	:	1508381500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY QUEZADA

Provider Business Mailing Address
First Line	:	465 39TH ST APT 3R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11232-2938
Country	:	US
Telephone Number	:	718-290-5593
Fax Number	:

Provider Business Practice Location Address
First Line	:	2748 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4735
Country	:	US
Telephone Number	:	646-237-3450
Fax Number	:

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

Provider Enumeration Date	:	08/10/2017
Last Update Date	:	08/10/2017

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Directions to “ KIMBERLY QUEZADA ” Practice Location

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