Healthcare Provider Details

I. General information

NPI: 1215105549
Provider Name (Legal Business Name): KATHLEEN A ESTONY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST LUKES DIALYSIS CENTER 4 CORWIN CT
NEWBURGH NY
12550
US

IV. Provider business mailing address

6 GENUNG CT
HOPEWELL JCT NY
12533-6110
US

V. Phone/Fax

Practice location:
  • Phone: 845-562-7711
  • Fax:
Mailing address:
  • Phone: 845-226-2096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000622
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: