Healthcare Provider Details

I. General information

NPI: 1003990946
Provider Name (Legal Business Name): WILLIAM KOHLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 ALBANY SHAKER RD
LOUDONVILLE NY
12211-1900
US

IV. Provider business mailing address

3 CORPORATE DR STE 100
HALFMOON NY
12065-8635
US

V. Phone/Fax

Practice location:
  • Phone: 518-435-1300
  • Fax:
Mailing address:
  • Phone: 518-348-1276
  • Fax: 518-383-8104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number003568
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: