Basic Information
| Provider Information | |||||||||
| NPI: | 1912929712 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUISHARD | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | ALEXANDER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 31724 | ||||||||
| Address2: | BROOKLYN HOSPITAL CENTER | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061501724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007772455 | ||||||||
| FaxNumber: | 6106176280 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 DEKALB AVENUE | ||||||||
| Address2: | BROOKLYN HOSPITAL CENTER | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182508000 | ||||||||
| FaxNumber: | 6106176280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| 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 | 207P00000X | 1542721 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01719855 | 05 | NY | MEDICAID |