Provider Demographics
NPI:1760743678
Name:YOUNG-MURRAY, KIMARA KIMBEL
Entity Type:Individual
Prefix:MRS
First Name:KIMARA
Middle Name:KIMBEL
Last Name:YOUNG-MURRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 ETNA ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-1418
Mailing Address - Country:US
Mailing Address - Phone:347-967-9880
Mailing Address - Fax:
Practice Address - Street 1:234 ETNA ST
Practice Address - Street 2:APT 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-1418
Practice Address - Country:US
Practice Address - Phone:347-967-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104415174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY252Y00000XMedicaid