Provider Demographics
NPI:1518111517
Name:NEARY, KIMBERLY CONSTANCE (MS)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CONSTANCE
Last Name:NEARY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:CONSTANCE
Other - Last Name:KORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 HICKSVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11518
Mailing Address - Country:US
Mailing Address - Phone:516-520-6000
Mailing Address - Fax:516-520-6080
Practice Address - Street 1:77 3RD AVE
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1924
Practice Address - Country:US
Practice Address - Phone:516-612-4643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006889235Z00000X
NY006889-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist