Provider Demographics
NPI:1366640062
Name:KINGSLEY, DAVID H (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:KINGSLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4018
Mailing Address - Country:US
Mailing Address - Phone:718-980-4700
Mailing Address - Fax:718-370-3745
Practice Address - Street 1:100 WHEELER AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4018
Practice Address - Country:US
Practice Address - Phone:718-980-4700
Practice Address - Fax:718-370-3745
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist