Doctor Name: | KIM BORAL |
NPI Number: | 1003047374 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | F301406 |
Business Practice Address: | 975 Stewart Ave Garden City, NY - 115304816 |
Business Phone Number: | 5162228600 |
Business Fax Number: | |
Mailing Address: | 40 Tower Rd, HOPEWELL JUNCTION |
State: | NY |
Postal Code: | 125337417 |
Phone Number: | 8452333726 |
Fax Number: | |
NPI Enumeration Date: | 08/04/2009 |
NPI Last Update Date: | 08/04/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | F301406 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |