Kimberly Bellan
Individual provider Active NPI Specialist · Medina, NY
NPI 1407212400 · NPPES record last updated Jan 6, 2016
Key facts
- NPI
- 1407212400
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 648558951 (NY)
- Practice address
- 3724 Bates Rd
Medina, NY 14103-9602 - Phone
- (585) 410-0591
- NPI assigned
- Jan 6, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 648558951 | NY | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 648558951 | NY | Yes |
Addresses
Primary practice location
3724 Bates Rd
Medina, NY 14103-9602
Mailing address
3724 Bates Rd
Medina, NY 14103-9602
Phone (585) 410-0591
Other providers in Medina, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.