Provider Demographics
NPI:1780897512
Name:KIMMEL, WARREN TZVI (DC)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:TZVI
Last Name:KIMMEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5043
Mailing Address - Country:US
Mailing Address - Phone:718-370-8882
Mailing Address - Fax:
Practice Address - Street 1:167 ROSS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7775
Practice Address - Country:US
Practice Address - Phone:718-852-9101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX93731Medicare ID - Type Unspecified