Healthcare Provider Details

I. General information

NPI: 1023622909
Provider Name (Legal Business Name): KATHLEEN NEWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN FAULKNER

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 OLD ROUTE 6
CARMEL NY
10512-2107
US

IV. Provider business mailing address

61 SANDS AVE APT 19
MILTON NY
12547-5148
US

V. Phone/Fax

Practice location:
  • Phone: 845-225-5202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number435150
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: