Active NPI
Nancy Kim, MA, PT
- Pediatric Physical Therapist
- Great Neck, NY
National Provider Identifier
1184937294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 015166-1
- Practice address
- 117 Shoreward Dr
Great Neck, NY 11021-2514 - Phone
- (516) 472-0121
- NPI assigned
- Jul 17, 2010
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 015166-1 | NY | Primary |
Addresses
Primary practice location
117 Shoreward Dr
Great Neck, NY 11021-2514
Mailing address
117 Shoreward Dr
Great Neck, NY 11021-2514
Phone (516) 472-0121
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)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015166-1 | NY | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279324800000",
"number": "1184937294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 SHOREWARD DR",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "110212514",
"telephone_number": "516-472-0121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 SHOREWARD DR",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "110212514",
"telephone_number": "516-472-0121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "NANCY",
"name_prefix": "Ms.",
"credential": "MA, PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-07-17",
"last_updated": "2010-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "NY",
"license": "015166-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Neck, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.