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Individual

KIMBERLY D. ZEDALIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2780 MIDDLE COUNTRY RD, STE 210, LAKE GROVE, NY 11755-2124
(631) 588-4500
(631) 588-4595
Mailing address
2780 MIDDLE COUNTRY RD, STE 210, LAKE GROVE, NY 11755-2124
(631) 588-4500
(631) 588-4595

Taxonomy

Speciality
Code
Description
License number
State
243U00000X
Radiology Practitioner Assistant
Primary
000142
NY
247100000X
Radiologic Technologist
956080
NY
2471M2300X
Mammography Radiologic Technologist
956080
NY

Other

Enumeration date
09/03/2008
Last updated
10/01/2008
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