Provider Demographics
NPI:1346778693
Name:KILLINGS, RANDY (CERT PEER SPEC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:KILLINGS
Suffix:
Gender:M
Credentials:CERT PEER SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FLATBUSH AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1101
Mailing Address - Country:US
Mailing Address - Phone:917-284-4131
Mailing Address - Fax:
Practice Address - Street 1:25 FLATBUSH AVE FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1101
Practice Address - Country:US
Practice Address - Phone:917-284-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYCPS-392175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist