Provider Demographics
NPI:1982673109
Name:HALLINAN, KIM MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:MARIE
Last Name:HALLINAN
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 1:40 ROCKFORD DR
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1122
Mailing Address - Country:US
Mailing Address - Phone:845-623-1119
Mailing Address - Fax:
Practice Address - Street 1:50 SANATORIUM RD
Practice Address - Street 2:BUILDING D
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3555
Practice Address - Country:US
Practice Address - Phone:845-364-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02076800Medicaid
NYP3142255OtherOXFORD HEALTH PLAN
NYF332371A12Medicaid
NY040426021478Medicaid
NY02076800Medicaid