Provider Demographics
NPI:1093100117
Name:HOOPER, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HOOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 W 35TH ST
Mailing Address - Street 2:1004
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1905
Mailing Address - Country:US
Mailing Address - Phone:646-230-8190
Mailing Address - Fax:646-230-8185
Practice Address - Street 1:237 W 35TH ST
Practice Address - Street 2:1004
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1905
Practice Address - Country:US
Practice Address - Phone:646-230-8190
Practice Address - Fax:646-230-8185
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator