Healthcare Provider Details

I. General information

NPI: 1205384187
Provider Name (Legal Business Name): MRS. AMANDA KERBEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA K CONNOR

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 SOUTH SCHODACK ROAD
CASTLETON ON HUDSON NY
12033-1708
US

IV. Provider business mailing address

100 N MOHAWK ST APT 123
COHOES NY
12047-1751
US

V. Phone/Fax

Practice location:
  • Phone: 518-477-7103
  • Fax:
Mailing address:
  • Phone: 518-926-9212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: