Organization Name: | KUMUDA FAMILY HEALTH CARE |
NPI Number: | 1215399522 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KIMBERLY JACKSON (OWNER) |
Mailing Address: | 31 Weber Hill Rd Mahopac |
State: | NY US |
Postal Code: | 105411829 |
Phone Number: | 9142608087 |
Fax Number: | |
NPI Enumeration Date: | 03/25/2016 |
NPI Last Update Date: | 03/25/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 336506 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |