Healthcare Provider Details

I. General information

NPI: 1245502731
Provider Name (Legal Business Name): KAITLIN SCHOMMER KUWITZKY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN SCHOMMER REID

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 TROY SCHENECTADY RD STE 101
LATHAM NY
12110-1074
US

IV. Provider business mailing address

55 MOHAWK ST
COHOES NY
12047-2600
US

V. Phone/Fax

Practice location:
  • Phone: 518-348-3176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number01655
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: