Provider Demographics
NPI:1356318851
Name:WOODS, KIM BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:BENJAMIN
Last Name:WOODS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E 149TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5601
Mailing Address - Country:US
Mailing Address - Phone:718-401-8030
Mailing Address - Fax:718-401-8033
Practice Address - Street 1:305 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5601
Practice Address - Country:US
Practice Address - Phone:718-401-8030
Practice Address - Fax:718-401-8033
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165573-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY165573OtherHIP
NY7102064002OtherCIGNA
NY134031158Other119
NY134031158OtherHORIZON
NY14E511OtherBC/BS
NY1000002323OtherAFFINITY
NY7594112OtherAETNA PPO
NYP589665OtherOXFORD
NY00984592Medicaid
NY594372OtherUNITED HEATH CARE
NY11P4451OtherNYPHP
NY134031158Other32BJ
NY2357778OtherAETNA
NY14E511OtherBC/BS
NY134031158Other32BJ
NY14E511Medicare ID - Type Unspecified