Individual
KIMBERLY M DESANTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
415 HOOPER RD, ENDWELL FAMILY PHYSICIANS LLP, ENDWELL, NY 13760-3646
(607) 754-3863
(607) 754-5697
Mailing address
415 HOOPER RD, ENDWELL, NY 13760-3646
(607) 754-3863
(607) 754-5697
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
211449
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01943728
—
NY
01
—
10074276
CDPHP
—
01
—
153925
EMPIRE BS
—
01
—
5997006
GHI
—
01
—
699965
MVP
—
01
—
71561388
CHAMPUS
—
01
—
7455028
AETNA HMO
—
01
—
76410
GHI HMO
—
Enumeration date
07/12/2006
Last updated
07/08/2007
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