Provider Demographics
NPI:1528224797
Name:NEW HERIZONS FAMILY MEDICINE P.C.
Entity Type:Organization
Organization Name:NEW HERIZONS FAMILY MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIBSON-BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-658-2090
Mailing Address - Street 1:3142B MOUNT MORRIS GENESEO RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:NY
Mailing Address - Zip Code:14510-9710
Mailing Address - Country:US
Mailing Address - Phone:585-658-2090
Mailing Address - Fax:585-658-4931
Practice Address - Street 1:3142B MOUNT MORRIS GENESEO RD
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-9710
Practice Address - Country:US
Practice Address - Phone:585-658-2090
Practice Address - Fax:585-658-4931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA1553Medicare PIN