Provider Demographics
NPI:1912601741
Name:HIGGINS, KYLE WILLIAM
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:WILLIAM
Last Name:HIGGINS
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 1:2378 35TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2209
Mailing Address - Country:US
Mailing Address - Phone:609-994-1949
Mailing Address - Fax:
Practice Address - Street 1:2378 35TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2209
Practice Address - Country:US
Practice Address - Phone:609-994-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician