Healthcare Provider Details

I. General information

NPI: 1255503686
Provider Name (Legal Business Name): KIMBERLY KOVACK HURLEY DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 BURRSTONE RD
NEW HARTFORD NY
13413-1001
US

IV. Provider business mailing address

1729 BURRSTONE RD
NEW HARTFORD NY
13413-1001
US

V. Phone/Fax

Practice location:
  • Phone: 315-798-1641
  • Fax:
Mailing address:
  • Phone: 315-798-1641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC005919
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00331700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN007150
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: