Healthcare Provider Details

I. General information

NPI: 1053376657
Provider Name (Legal Business Name): KATHLEEN WOODS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E 23RD ST
MANHATTAN NY
10010-5011
US

IV. Provider business mailing address

20 CRONISER DR
HOPEWELL NY
12533-6156
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-7500
  • Fax: 212-951-6847
Mailing address:
  • Phone: 212-686-7500
  • Fax: 212-951-6847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF302904
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: