Healthcare Provider Details

I. General information

NPI: 1427040708
Provider Name (Legal Business Name): KATHLEEN ENNABI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 ROUTE 52 SUITE 3
HOPEWELL JUNCTION NY
12533-3247
US

IV. Provider business mailing address

22 SAW MILL RIVER RD
HAWTHORNE NY
10532-1533
US

V. Phone/Fax

Practice location:
  • Phone: 845-227-0123
  • Fax: 845-227-0345
Mailing address:
  • Phone: 914-593-1606
  • Fax: 914-593-1790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number234314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: