MEDICARE: JANE KINNEARY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	0212231	NY

General Provider Information

NPI Number	:	1205217767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE KINNEARY

Provider Business Mailing Address
First Line	:	254 COUNTY ROAD 2
Second Line	:
City	:	GREENE
State	:	NY
Zip	:	13778-2290
Country	:	US
Telephone Number	:	607-242-1772
Fax Number	:

Provider Business Practice Location Address
First Line	:	254 COUNTY ROAD 2
Second Line	:
City	:	GREENE
State	:	NY
Zip	:	13778-2290
Country	:	US
Telephone Number	:	607-242-1772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2015
Last Update Date	:	11/18/2015

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