Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 214093 | NY |
NPI | 1215940671 |
---|---|
Provider Name | Dr. Gary Kimmel |
First Address | Brooklyn, NY 11215-3710 |
Second Address | Brooklyn, NY 11215-3710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H69954 | (02) | NY |