Provider Demographics
NPI:1235497769
Name:APOLINAR, KIMBERLY LEE (PA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LEE
Last Name:APOLINAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:205 E MAIN ST
Mailing Address - Street 2:SUITE 2-6
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2923
Mailing Address - Country:US
Mailing Address - Phone:631-923-2370
Mailing Address - Fax:631-923-2371
Practice Address - Street 1:205 E MAIN ST
Practice Address - Street 2:SUITE 2-6
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2923
Practice Address - Country:US
Practice Address - Phone:631-923-2370
Practice Address - Fax:631-923-2371
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant