Provider Demographics
NPI:1669645818
Name:LEVY, KIMBERLEY JEAN (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:JEAN
Last Name:LEVY
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 MIDDLE COUNTRY ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLANA
Mailing Address - State:NY
Mailing Address - Zip Code:11953
Mailing Address - Country:US
Mailing Address - Phone:631-345-6670
Mailing Address - Fax:631-482-1356
Practice Address - Street 1:281 MIDDLE COUNTRY ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLANA
Practice Address - State:NY
Practice Address - Zip Code:11953
Practice Address - Country:US
Practice Address - Phone:631-345-6670
Practice Address - Fax:631-482-1356
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012425363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical