Provider Demographics
NPI:1952546632
Name:KIM, ERIC (DPT)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-2029
Mailing Address - Country:US
Mailing Address - Phone:516-488-6356
Mailing Address - Fax:516-437-2936
Practice Address - Street 1:72 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-2528
Practice Address - Country:US
Practice Address - Phone:516-437-5300
Practice Address - Fax:516-437-2936
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030723-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist