Provider Demographics
NPI:1477390375
Name:KIMMEL, SUSAN ELIZABETH (DVM DIPL ACVIM (SAIM)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:DVM DIPL ACVIM (SAIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 CANTIAGUE ROCK RD UNIT 5
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1721
Mailing Address - Country:US
Mailing Address - Phone:516-420-0000
Mailing Address - Fax:516-420-0122
Practice Address - Street 1:609 CANTIAGUE ROCK RD UNIT 5
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1721
Practice Address - Country:US
Practice Address - Phone:516-420-0000
Practice Address - Fax:516-420-0122
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine