Provider Demographics
NPI:1639299456
Name:KIMELFELD, ANNA (NP)
Entity Type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:
Last Name:KIMELFELD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3869 SURF AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1228
Mailing Address - Country:US
Mailing Address - Phone:718-372-1115
Mailing Address - Fax:
Practice Address - Street 1:3015 W 29TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1901
Practice Address - Country:US
Practice Address - Phone:718-266-5700
Practice Address - Fax:718-265-1590
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303583363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ16964Medicare UPIN