Individual
MRS. KIMONE VALESHA MULLINGS-GREENLEES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
391 E 149TH ST, BRONX, NY 10455-3907
(646) 702-6965
Mailing address
3745 BARNES AVE, BRONX, NY 10467-5822
(347) 734-5072
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
877724988
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
877724988
NEW YORK STATE ID
NY
Enumeration date
04/01/2019
Last updated
04/01/2019
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