Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 058745 | NY |
N | 1223P0221X | Pediatric Dentist | 22DI02619400 | NJ |
NPI | 1083039234 |
---|---|
Provider Name | Kimberli Leal |
First Address | New York, NY 10024-5255 |
Second Address | New York, NY 10002-4700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2014 |
Last Update Date | 06/03/2017 |