Individual
KIM ELAINE BACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2079 WANTAGH AVE STE 4, WANTAGH, NY 11793-3924
(516) 244-6968
Mailing address
2079 WANTAGH AVE, WANTAGH, NY 11793-3924
(516) 244-6968
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402879
NY
Other
Enumeration date
01/02/2020
Last updated
08/01/2025
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