Healthcare Provider Details

I. General information

NPI: 1235545963
Provider Name (Legal Business Name): KIMBERLY M HADIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERY MCKENNEY MD

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 COURT ST
CANTON NY
13617-1136
US

IV. Provider business mailing address

24 WOODS DR
CANTON NY
13617-1061
US

V. Phone/Fax

Practice location:
  • Phone: 646-352-3216
  • Fax:
Mailing address:
  • Phone: 646-352-3216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number290105-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: