Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | 012683-1 | NY |
NPI | 1679792055 |
---|---|
Provider Name | Ms. Kimberly K Stavrolakes |
First Address | Bedford, NY 10506-2017 |
Second Address | New York, NY 10032-3720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |