Provider Demographics
NPI:1821351362
Name:OPPENHEIMER, KIM TRIXI (MA)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:TRIXI
Last Name:OPPENHEIMER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W 75TH ST
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-1814
Mailing Address - Country:US
Mailing Address - Phone:212-724-9304
Mailing Address - Fax:
Practice Address - Street 1:105 W 75TH ST
Practice Address - Street 2:SUITE 4B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-1814
Practice Address - Country:US
Practice Address - Phone:212-724-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist