Healthcare Provider Details

I. General information

NPI: 1114618436
Provider Name (Legal Business Name): KATHRYN SKOLNICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 W MAIN ST
OWEGO NY
13827-1578
US

IV. Provider business mailing address

507 MAIN ST
JOHNSON CITY NY
13790-1810
US

V. Phone/Fax

Practice location:
  • Phone: 607-687-0350
  • Fax:
Mailing address:
  • Phone: 607-763-6075
  • Fax: 607-763-5234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number340652
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: