Provider Demographics
NPI:1356568968
Name:GREEN-MAYER, KIMBERLY (DO)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:GREEN-MAYER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DEVON RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1659
Mailing Address - Country:US
Mailing Address - Phone:347-262-0056
Mailing Address - Fax:
Practice Address - Street 1:6940 MAIN ST
Practice Address - Street 2:
Practice Address - City:KEW GARDENS HILLS
Practice Address - State:NY
Practice Address - Zip Code:11367-1723
Practice Address - Country:US
Practice Address - Phone:718-268-5282
Practice Address - Fax:718-261-4359
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236212208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics