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Individual

KIM WADE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSED

Contact information

Practice address
25 VERNON AVE, BROOKLYN, NY 11206-6409
(347) 529-3980
Mailing address
25 VERNON AVE, BROOKLYN, NY 11206-6409
(347) 529-3980

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
171WOOOOOX
NY

Other

Enumeration date
03/09/2015
Last updated
03/09/2015
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