Provider Demographics
NPI:1225231285
Name:KIENINGER, GERALDINE WALSH (PNP)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:WALSH
Last Name:KIENINGER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 1ST AVE # AVENUE-3D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-1819
Mailing Address - Country:US
Mailing Address - Phone:212-982-4549
Mailing Address - Fax:
Practice Address - Street 1:120 E 75TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3240
Practice Address - Country:US
Practice Address - Phone:212-734-3338
Practice Address - Fax:212-734-1710
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3808671363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics