Provider Demographics
NPI:1518903418
Name:ALESSI, KIMBERLY (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ALESSI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5066
Mailing Address - Country:US
Mailing Address - Phone:518-869-6220
Mailing Address - Fax:518-869-6465
Practice Address - Street 1:2 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1702
Practice Address - Country:US
Practice Address - Phone:518-869-6220
Practice Address - Fax:518-869-6465
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026315-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA7879Medicare ID - Type Unspecified