Provider Demographics
NPI:1942568621
Name:STARTZ, KIMBALLI P (HIS)
Entity type:Individual
Prefix:
First Name:KIMBALLI
Middle Name:P
Last Name:STARTZ
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 POST RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7140
Mailing Address - Country:US
Mailing Address - Phone:401-921-0181
Mailing Address - Fax:401-921-5826
Practice Address - Street 1:3520 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-921-0181
Practice Address - Fax:401-921-5826
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000322237700000X
RIHAD00124237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI261116920OtherTAX ID