Provider Demographics
NPI:1730416835
Name:KING, CYNTHIA P
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:P
Last Name:KING
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 1:1 KENSINGTON GATE APT 105
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1228
Mailing Address - Country:US
Mailing Address - Phone:516-510-5736
Mailing Address - Fax:888-337-1274
Practice Address - Street 1:1 KENSINGTON GATE APT 105
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1228
Practice Address - Country:US
Practice Address - Phone:516-510-5736
Practice Address - Fax:888-337-1274
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095265174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator