Healthcare Provider Details

I. General information

NPI: 1164804902
Provider Name (Legal Business Name): MELANIE KOBY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2015
Last Update Date: 06/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 ROUTE 44 55
GARDINER NY
12525-5128
US

IV. Provider business mailing address

2812 ROUTE 44 55
GARDINER NY
12525-5128
US

V. Phone/Fax

Practice location:
  • Phone: 845-527-2957
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number424937-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: