Provider Demographics
NPI:1003342056
Name:KIM, MOLLY SUE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:SUE
Last Name:KIM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:MOLLY
Other - Middle Name:SUE
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:150 E 42ND ST FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5699
Mailing Address - Country:US
Mailing Address - Phone:646-605-8186
Mailing Address - Fax:
Practice Address - Street 1:10 E 102ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6030
Practice Address - Country:US
Practice Address - Phone:212-241-6756
Practice Address - Fax:212-423-0522
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily