Provider Demographics
NPI:1275191967
Name:KIMMEL, ALLISON URBANIK (LAC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:URBANIK
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 WARREN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6520
Mailing Address - Country:US
Mailing Address - Phone:860-930-2459
Mailing Address - Fax:
Practice Address - Street 1:911 UNION ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1566
Practice Address - Country:US
Practice Address - Phone:860-930-2459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006517-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist