Individual provider Active NPI

Kimberly Anne Tardalo, FNP

  • Family Nurse Practitioner
  • New York, NY
National Provider Identifier
1639618275
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
341458 Issued in NY
Practice address
160 E 34TH St
New York, NY 10016-4744
Phone
(212) 731-5366
NPI assigned
Feb 15, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 675235 NY
Family Nurse Practitioner 363LF0000X 341458 NY Primary

Addresses

Primary practice location

160 E 34TH St
New York, NY 10016-4744

Mailing address

160 E 34TH St
New York, NY 10016-4744
Phone (212) 731-5366

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180226000970 NY Order and Referring Only - Nurse Practitioner 8729349238

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
675235NYMDRegistered Nurse
341458NYMDFamily Nurse Practitioner

Interoperability endpoints

  • Direct secure messaging: ktardalo82967@nyumc.direct-ci.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1639618275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 E 34TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100164744",
            "telephone_number": "212-731-5366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 E 34TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100164744",
            "telephone_number": "212-731-5366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARDALO",
        "first_name": "KIMBERLY",
        "middle_name": "ANNE",
        "name_prefix": "Miss",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-15",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "675235",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "341458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.