MEDICARE: KINGSTON INTERNAL MEDICINE ASSOCIATES, P.C.

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	173000000X	Legal Medicine	149865	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548294796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGSTON INTERNAL MEDICINE ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	368 BROADWAY STE 403
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-5160
Country	:	US
Telephone Number	:	845-338-2727
Fax Number	:	845-338-2975

Provider Business Practice Location Address
First Line	:	368 BROADWAY STE 403
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-5160
Country	:	US
Telephone Number	:	845-338-2727
Fax Number	:	845-338-2975

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DIANE LYNN KEMBLE
Credential	:
Telephone Number	:	845-338-2727

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/11/2008

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