Provider Demographics
NPI:1447071204
Name:PRESSLEY, KIM
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:PRESSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 SURF DR
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2536
Mailing Address - Country:US
Mailing Address - Phone:917-482-1118
Mailing Address - Fax:
Practice Address - Street 1:126 SURF DR
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2536
Practice Address - Country:US
Practice Address - Phone:917-482-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17440000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist