Active NPI
Laura Kimeldorf, M.D.
- Psychiatry Physician
- Port Washington, NY
National Provider Identifier
1043445216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 260696
- Practice address
- 23 Locust Ave
Port Washington, NY 11050-2711 - Phone
- (646) 598-6463
- NPI assigned
- May 18, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 260696 | NY | Primary |
Addresses
Primary practice location
23 Locust Ave
Port Washington, NY 11050-2711
Mailing address
23 Locust Ave
Port Washington, NY 11050-2711
Phone (646) 598-6463
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 260696 | NY | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651622400000",
"number": "1043445216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 LOCUST AVE",
"city": "PORT WASHINGTON",
"state": "NY",
"postal_code": "110502711",
"telephone_number": "646-598-6463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 LOCUST AVE",
"city": "PORT WASHINGTON",
"state": "NY",
"postal_code": "110502711",
"telephone_number": "646-598-6463"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMELDORF",
"first_name": "LAURA",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-05-18",
"last_updated": "2022-05-04",
"certification_date": "2022-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "260696",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Washington, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.