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Individual

KIM GABRIELLE WALLENSTEIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D., PH.D.

Contact information

Practice address
725 IRVING AVE, SUITE 401, SYRACUSE, NY 13210-1603
(315) 464-2878
(315) 464-2879
Mailing address
2 GRAMPIAN RD, APT 9, LIVERPOOL, NY 13090-5010

Taxonomy

Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
257433
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03254340
NY
Enumeration date
04/13/2007
Last updated
12/06/2012
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