Healthcare Provider Details

I. General information

NPI: 1215027404
Provider Name (Legal Business Name): KATHLEEN ELIZABETH DROESCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CORPORATE CENTER DR SUITE 101
MELVILLE NY
11747-3193
US

IV. Provider business mailing address

22 WATERVILLE RD INVITRO SCIENCES, INC
AVON CT
06001-2066
US

V. Phone/Fax

Practice location:
  • Phone: 631-752-0606
  • Fax: 631-752-0623
Mailing address:
  • Phone: 860-678-3428
  • Fax: 860-284-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number158316
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number158316
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: