Healthcare Provider Details

I. General information

NPI: 1316090442
Provider Name (Legal Business Name): KELLY BATTOGLIA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2007
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WILLOW POND WAY STE 100
PENFIELD NY
14526-2689
US

IV. Provider business mailing address

2460 BROWNCROFT BLVD
ROCHESTER NY
14625-1410
US

V. Phone/Fax

Practice location:
  • Phone: 585-641-0399
  • Fax:
Mailing address:
  • Phone: 585-704-1130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number360248
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: