Provider Demographics
NPI:1184764565
Name:VOLMAN, KIM
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:VOLMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1907
Mailing Address - Country:US
Mailing Address - Phone:718-368-9800
Mailing Address - Fax:718-368-9700
Practice Address - Street 1:3735 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1907
Practice Address - Country:US
Practice Address - Phone:718-368-9800
Practice Address - Fax:718-368-9700
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02331900Medicaid
NY02331900Medicaid