Individual
KIMBERLY STONE HALTIWANGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
646 COMMACK RD, COMMACK, NY 11725-5404
(631) 499-4114
(631) 499-1468
Mailing address
646 COMMACK RD, COMMACK, NY 11725-5404
(631) 499-4114
(631) 499-1468
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
188281
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00401381
—
NY
05
—
01821338
—
NY
Enumeration date
07/13/2006
Last updated
07/09/2007
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