Provider Demographics
NPI:1710151949
Name:SCHMIDT, KIMBERLY GRACE (PA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:GRACE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:496 SMITHTOWN BYP STE 200
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5011
Mailing Address - Country:US
Mailing Address - Phone:631-361-5300
Mailing Address - Fax:631-361-5301
Practice Address - Street 1:496 SMITHTOWN BYP STE 200
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-361-5300
Practice Address - Fax:631-361-5301
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY007810363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical