Healthcare Provider Details

I. General information

NPI: 1295097186
Provider Name (Legal Business Name): KATHY A CHAPIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 SOUTHWOODS DR
MONTICELLO NY
12701-7231
US

IV. Provider business mailing address

36 KELLY AVENUE
LIBERTY NY
12754-1333
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-6037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number750606
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: