Healthcare Provider Details

I. General information

NPI: 1275576985
Provider Name (Legal Business Name): MRS. KATIE ELLEN GALDERISI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE ELLEN DEDRICK

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 9D
CASTLE POINT NY
12511
US

IV. Provider business mailing address

277 MILLERS LN
KINGSTON NY
12401-4742
US

V. Phone/Fax

Practice location:
  • Phone: 845-831-2000
  • Fax: 845-838-5184
Mailing address:
  • Phone: 845-831-2000
  • Fax: 845-838-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number013762-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: