Healthcare Provider Details

I. General information

NPI: 1508862228
Provider Name (Legal Business Name): KELLY A COMERFORD DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3403 CARMAN RD
SCHENECTADY NY
12303
US

IV. Provider business mailing address

3403 CARMAN RD
SCHENECTADY NY
12303-5319
US

V. Phone/Fax

Practice location:
  • Phone: 518-356-9835
  • Fax: 518-357-0470
Mailing address:
  • Phone: 518-356-9835
  • Fax: 518-357-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number0058732
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: