Healthcare Provider Details

I. General information

NPI: 1912690793
Provider Name (Legal Business Name): MELISSA MARIE KOBITO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
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: 315-798-1805
  • Fax: 315-798-1708
Mailing address:
  • Phone: 315-798-1805
  • Fax: 315-798-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number351804
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: