Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F301406 | NY |
NPI | 1003047374 |
---|---|
Provider Name | Kim Boral |
First Address | Hopewell Junction, NY 12533-7417 |
Second Address | Garden City, NY 11530-4816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2009 |
Last Update Date | 04/08/2009 |