Basic Information
| Provider Information | |||||||||
| NPI: | 1699784876 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIMMEL | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | JEROME | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 48 THE OAKS | ||||||||
| Address2: | |||||||||
| City: | ROSLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115761706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164844458 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4422 3RD AVE | ||||||||
| Address2: | DENTAL DEPARTMENT-ST. BARNABAS HOSPITAL | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104572545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189609000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 023248 | NY | Y | Dental Providers | Dentist | General Practice |
No ID Information.