Provider Demographics
NPI:1730425554
Name:MCCOY, KIMBERLY (MSED,, ESQ)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MSED,, ESQ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 EDGECOMBE AVE
Mailing Address - Street 2:14H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4406
Mailing Address - Country:US
Mailing Address - Phone:212-795-3690
Mailing Address - Fax:
Practice Address - Street 1:555 EDGECOMBE AVE
Practice Address - Street 2:14H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4406
Practice Address - Country:US
Practice Address - Phone:212-795-3690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist