Provider Demographics
NPI:1104394204
Name:GARVEY, KIMBERLY RAY (PA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RAY
Last Name:GARVEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 PEACE ST
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-3431
Mailing Address - Country:US
Mailing Address - Phone:914-494-7799
Mailing Address - Fax:
Practice Address - Street 1:55 PALMER AVE
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3403
Practice Address - Country:US
Practice Address - Phone:914-787-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022889363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty